
Glass 
Book. 



COPYRIGHT DEPOSIT 



OF 



THE PHYSICAL TREATMENT 



CHILDREN. 



PUBLISHER'S ADVERTISEMENT. 

The present edition of this valuable work contains the revi- 
sions and additions of the author, made by him a short time 
previously to his death. 

Philadelphia } 1853. 



TREATISE 



PHYSICAL AND MEDICAL TREATMENT 



CHILDREN. 



BY 

WILLIAM P. DEWEE8, M. D„ 

late professor of midwifery in the university of pennsylvania; member 

of the american philosophical society; of the royal medical 

society of denmark; of the philadelphia medical 

society; lecturer on midwifery; &c, &g. 



€mty (Kuitintr, 



WITH THE AUTHOR'S LAST IMPROVEMENTS ANE> CORRECTION 




PHILADELPHIA: 

BLANCHARD AND LEA. 

1853. 






Entered according to Act of Congress, on the fifth day of October, in the 
year 1853, by 

BLANCHARD & LEA, 

in the Clerk's Office of the District Court for the Eastern District of the State of 

Pennsylvania. 



TO 

THOMAS C. JAMES, M.D., 

PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF PENNSYLVANIA, 

€\h SJnrk 

13 MOST RESPECTFULLY AND AFFECTIONATELY INSCRIBED, 

BY HIS FRIEND, 

THE AUTHOR 

Philadelphia, January., 1838, 



PREFACE. 



"We thought it would be useful, before we treated of the dis- 
eases of children, to give a summary of the physical treatment 
of children. This subject, though deserving of consideration, 
is almost new in this country. In treating of this important part 
of education, we have consulted some of the best authorities on 
the subject, and have also endeavoured to make our own expe- 
rience useful. By appealing to experience and reason, we have 
tried to avoid speculation ; and have not permitted ourselves to 
be seduced into the diffuseness of Jean Jacques Rousseau, nor 
to rest contented with the limited, though generally correct, views 
of Faust. We have endeavoured to condense most of the im- 
portant points, which reason has dictated, or experience has 
sanctioned, within as narrow a compass as appeared consistent 
with perspicuity. 

The physical treatment of children, in its details, is almost 
infinitely diversified ; for custom, prejudice, and speculation, have 
imposed regulations which, in their extent, are neither sanc- 
tioned by reason nor experience. The first declares its influence 
by the perpetuation of restraints upon the body and limbs of the 
passive child, by which it is moulded to the form that caprice 
or hypothesis judges best for its future health or proportions — 
hence the continuance of the unnatural practice of "swaddling." 

We cannot but regard as flne of the greatest improvements in 
modern physical education, the now almost universal abandon- 
ment of swathes and stays. This unnatural practice will, doubt- 
less, be hereafter looked upon as "a tale of the olden time," 
when fable usurped the place of truth; for we are not certain, 
even at this moment, it will obtain belief, that, in Great Britain, 



Vlll PREFACE. 

half a century ago, this custom was almost universal. Dr. Buchan 
informs us, (Advice to Mothers, p. 108,) that he was very in- 
strumental in abolishing this cruel and absurd practice. His 
Inaugural Dissertation was upon this subject ; and when he re- 
commended a loose and easy dress for children newly born, he 
had not only to contend against the force of custom, and the 
stubbornness of prejudice, but also against the opinion of the 
"Medical Faculty of the University of Edinburgh" itself. 

It may not be amiss to state, for the information of those who 
have heard of " swaddling," but who are ignorant of its mean- 
ing, that this practice consists in nearly depriving the child of 
the use of its limbs, by enveloping them in an endless length of 
bandage, so as to make them not unaptly resemble billets of 
wood. By this means, the skin was sometimes excoriated ; the 
flesh compressed almost to gangrene; the circulation nearly ar- 
rested, and the child left without the slightest power of motion. 

Its little waist was surrounded by stays of such stiffness, and 
such strictness of application, as to forbid flexion, either back- 
ward or forward, or, indeed, motion of any kind. Its head was 
compressed into such a form as the fancy ©f the midwife might 
suggest; and its shape maintained by properly adjusted pres- 
sure, by means of bandages. In fact, the talents of the mid- 
wife were estimated at this time, by her dexterity in the appli- 
cation of swathes, rather than by her professional acquirements. 
When the child was completely dressed in its bandages, it but 
too nearly resembled the form of an Egyptian mummy; and, 
like its prototype, might, it is said, have been safely thrown any 
where, as the swathing would protect it from being injured by 
such rudeness. In a word, it had no resemblance to any thing 
living : its frequent but unavailing cries alone determined it to 
be human. 

The second shows its influence in the almost entire confor- 
mity to usage, though a more rational mode is constantly pre- 
senting itself for imitation ; — hence the continuance of customs, 
however pernicious and preposterous, by foreigners, among those 
who are more rational in their habits and manners. 

The third, from preconceived notions, prescribes rules, for that 
which it would be desirable to attain, rather than that which is 
practicable ; hence the many European notions of Jean Jacques 



PREFACE. IX 

Rousseau. It would, therefore, seeui, that this important part 
of education consists rather in usage than in regulations based 
upon reason and experience; for, were these to be the founda- 
tion, much less difference would be found in the education of 
children than at present exists. 

The education we are now considering consists in the develop- 
ment of the physical and moral powers of man ; consequently, 
that scheme which does this in the most perfect manner, must 
be the best — but much discrepancy prevails in what the scheme 
should consist. We make no pretensions to originality ; nor shall 
we boast of any superiority, in our present endeavour, over the 
systems which have gone before us ; we merely hope that the re- 
sult of long observation and experience will not be altogether 
unavailing. 

It will be seen, by the arrangement of our subject, that it is 
our opinion that the physical treatment of children should begin, 
as far as may be practicable, with the earliest formation of the 
embryo : it will, therefore, necessarily involve the conduct of 
the female even before her marriage, as well as during the period 
of pregnancy. It will also be obvious, that the various contin- 
gencies which may affect her, as well in health, as in disease, 
must also exert an influence upon the foetus. To the mother, 
then, we have addressed a few directions, that she may be enabled 
to contribute to the healthful stamina of her child, about to be 
born. 

We would not, however, positively say, with some, that every 
man is nothing more nor less than that which his mother has 
made him ; nor that to her care, alone, he is indebted for a vi- 
gorous constitution ; nor to her neglect that he must solely at- 
tribute a feeble frame : yet we dare advance, that very much de- 
pends on her either to insure the one, or prevent the other. 

To insure the first of these objects, and to prevent the other, 
it would seem evident that the woman herself must possess healthy 
and, at all times to preserve this, is not only highly desirable, 
but it becomes an imperious duty, if she have a suspicion she is 
about to become a mother; for now she has committed to her 
trust the future welfare of a being, to whom she should be united 
by the most tender and endearing of ties. 

Let her, then, in early life convince herself, that an awful re- 



X PREFACE. 

sponsibility is attached to the title of "mother;" and that, if 
she enter into the holy state of marriage with heedless haste ; 
and without weighing the nature and importance of the duties she 
voluntarily imposes on herself, she will but too certainly dis- 
charge them without pleasure, if not with reprehensible neglect. 

As the influence of the maternal constitution upon the embryo 
must be admitted, we have thought it proper to suggest how 
much a woman owes it to herself, as well as to society, that she 
enter not into the marriage state while labouring under such dis- 
qualifications as will be sure to entail debility or disease upon 
her offspring; we have, therefore, directed our first chapter to 
this object. 

In such horror did the ancients hold such marriages, that, 
under the pretext of serving the public weal, the offspring were 
often condemned to death, without feeling or remorse. 

The cruel and severe laws of Lycurgus forbade the parent to 
take charge of his child, or educate him according to his own 
mode; it was always submitted to the inspection of a jury of 
elders, whose decision was final. Should the child be found 
lively, robust and well-shaped, it was maintained at the public 
expense, and had a certain portion of the public wealth assigned 
it; and from that moment it became the property of the republic ; 
hut if, on the other hand, it were found feeble, deformed or 
crippled, it was by the same power, without mercy or hesitation, 
consigned to death, by throwing it into the Apothetes. 

There is no fact better established, than that the stamina l of 
offspring almost exclusively depends upon the good health of 
the parents ; and that upon the original healthy dispositions of 
the child will the success of well directed physical education 
very much depend ; for upon the judicious application of physi- 
cal agents healthy development takes place ; and by their mis- 
application, the soundest stamina may be converted into never- 
ending debility, or pitiable helplessness. 2 

* We employ this term in the singular, from usage, and not from the rules of 
grammar. 

* The pulse of children when very young is not to be relied on ; that is, as to 
frequency; and of course, it requires a long experience to determine it; conse- 
quently, much reliance cannot be placed upon it: it is generally supposed that a 
child's pulse is much more frequent than an adult's; but, from the experiments 
of M. Billard, this is not the case: he says that "this is only true in the greatest 



PREFACE. XI 

How important, then, is good conduct, both before and after 
marriage, to the formation of healthy stamina. And how espe- 
cially essential and proper are certain observances of the mo- 
ther during pregnancy, that she may insure desirable disposi- 
tions to her infant; at least, so far as she is capable of impart- 
ing them during that period. And, on the other hand, how re- 
prehensible is that heedless selfishness of the mother, who, for 
a momentary gratification, neglects the opportunity of impart- 
ing health and vigour to her offspring. 

To constitute a mother, in the best sense of the term, much 
more is required than giving birth to progeny — it requires quali- 
ties both rare and estimable ; it exacts a patient endurance of fa- 
tigue, and anxious solicitude, as well as a submission to privations, 
which nothing will render supportable but that love of offspring 
which a kind Providence has so generally and so deeply im- 
planted in the female heart. Thus, the toil and danger of child- 
birth ; the fatigue and anxiety of nursing, and the responsibility 
of education, exclusively for a time devolve upon the female. Can 
the attempt, then, to diminish the first, to relieve the second, 
and divide the third, be unacceptable ? 

Is it not both unfortunate and unjust, that the responsibility 
and care of early education should so exclusively devolve on the 
mother? For it is every way sufficiently severe upon her to su- 
perintend the concerns of her establishment, if it be an object 
that these shall be well and economically managed, without the 
burden and perplexity of educating her children. 

It is time, then, that some changes were made, which would 
tend to the relief of the over-burdened mother ; and this can be 
most profitably done, by the father partaking in this arduous and 
interesting duty. This would not only contribute to the relief 

number of cases, while, in many, the pulse is nearly as slow as that of some old 
men. That in forty children, aged from one to ten days, apparently in good 
health, there were 13 where the pulse beat less than 80; in two it beat 86; in 
one, 89; in four, 100; in ten, from 110 to 125; in one 130; in two, 145; in two, 
150; in one, 180. Thus, there were as many children in whom the pulse ex- 
hibited about the same number of beats as is usually observed in an adult, as there 
were of those in whom it beat with much greater rapidity. The pulse increases 
in frequency in proportion as the child advances in age. It is often irregular in 
the young infant, jerking, small, thread-like, and easily compressed, and not al- 
ways isochronous with the beats of the heart. The pulsations also are often so 
indistinct as to render it impossible to count them."' 



XU PREFACE. 

of the mother, but would command a conformity from the child r 
that would be highly useful to its future welfare. 

Besides, the father, from his education and studies, is, for the 
most part, better qualified to direct and enforce a proper system 
of physical education. But, unfortunately, at present, every 
thing connected with the nursery and education, is " voted a 
bore," by the modern fine gentleman; and the physical treat- 
ment of his children is a duty he would feel almost disgraced to 
perform. Not so felt a Cato, an Augustus, a Henry the Fourth, 
or a Montaigne: they felt it worthy their most serious regard. 

The table of contents will nearly explain our plan; we have 
commenced with considerations on marriage ; we have given di- 
rections for the conduct of the mother during pregnancy, labour, 
and the month of confinement ; pointed out what is proper for 
the child during that period ; attempted to convince the mother 
it is her duty to suckle her child ; or, in case she cannot, what 
is the next best course ; considered what is the best method of 
clothing, dressing, feeding, and exercising the child ; explained 
the nature of our atmosphere ; shown in what its purity and its 
deterioration depend ; in a word, we have attempted to deter- 
mine the influence of physical agents upon the constitution of 
the being, from its embryo existence to that state of develop- 
ment called puberty. 



TABLE OF CONTENTS 



BOOK I 



PART I. 

PAGE. 

Chap. I. Of Marriage 17 

Sect. I. Of the Period of Life . . . . IT 

II. Of Constitution 20 

III. Of Predisposition . . . . 21 

IV. Of the Immediate state of Health . . 22 
II. Of the conduct of the Mother during Pregnancy . 25 

III. Of the Influence of Imagination .... 32 

IV. Of the Indulgence of Temper 38 

V. Of the Food proper for Pregnant Women . . 39 

VI. Of the Conduct to be observed during Labour . . 42 

VII. Of the Conduct during the Month . . . . 44 

VIII. Observations enforcing the foregoing Rules . . 45 

IX. Of the Treatment of the Nipples .... 49 

X. Of the Mother Suckling her Child .... 51 

XI. Of Physical Injuries to the Child . . ... 57 

XII. Of Moral Injuries 62 

XIII. Of Dressing the Child 63 

Sect. I. Of Washing 63 

II. Of the Dress of the Child ... 66 

III. Of the Belly-band .... 72 

IV. Of the General Dress of the Child . . 74 
V. Of Changing the Child .... 79 

XIV. Of Feeding the Child in the Month .... 79 
XV. Of Observances towards the Mother during the Month 82 

XVI. Of the Duties of the Mother after the Month . . 86 
XVII. Recapitulation of the Instructions given to the Female 
during Pregnancy, Labour, and Confinement, as well 
as Rules for the general Management of the Child 

during the Month 91 

XVIII. Of the Nursery 95 



XIV 



TABLE OF CONTENTS. 



PART II. 



II. 



III. 



IV. 



Chap. I. First Period 

Sect. I. Of Crying . 
II. Of Sleep . 
III. Of the Necessities of the Child 

Of the Air 

Sect. I. Of Temperature . 
II. Of Fashion . 
III. Of Exposure and " Hardening 

Of Food 

Sect. I. Causes which may Render it Improper 
for the Mother to Suckle her Child 
Of the Meconium and its Management 
Of the proper Nourishment for the Child . 
VI. Of Partial or x\rtificial Nursing 

Sect. I. First Means, or where the Mother Suckles 
her Child 
II. Second Means 
III. Third Means 
Second Period. Of Weaning . 

Sect. I. On the Part of the Mother 
On the Part of the Child 
A— Of the Teeth 
B— Of the Child's Health 
Of the Season of the Year 



VII. 



II. 



III. 

VIII. Of Teething 

Sect. I. 

II. 



Of the Phenomena of Teething 
Of Second Dentition 
IX. Of the Food proper after First Dentition and Weaning 
X. Are there substances in Common Use ; absolutely hurt 

ful to Children? 

Sect. I. Of Fruit in general, and of Fresh Fruits 
II. Of Dried Fruits .... 

XI. Of Exercise 

Sect. I. Of Carrying in the Arms 

II. Of Walking . . . . 

III. Of Other modes of Exercise . 
A — Riding in a Carriage . 
B — Riding on Horseback . 
C — Of Games and Exercises of various 

kinds .... 
D— Dumb-Bells 



TABLE OF CONTENTS. 



XV 



XII. Of Bathing and Cleanliness . 

XIII. Of Dress • . . 

Sect. I. Of the Form of the Garments 

II. Of the Quantity and Quality of Clothing 

PART III. 
Chap. I. Observances from Second Dentition to Puberty 



PAGE. 

210 
218 
218 
219 



224 



BOOK II. 



OF THE DISEASES OF CHILDREN. 
Chap. I. Of the Want of Respiration 
II. Of Syncope, or Fainting 
II T. Of the Meconium .... 

IV. Of Jaundice 

V. Of Erysipelas .... 

VI. Of Retention of Urine . 
VII. Of Aphthae . . . 

VIII. Of Colic 

IX. Of Ophthalmia .... 
X. Of Ulceration of the Mouth 
XI. Of the Inflammation and Swelling of the 



Breasts o 



new-born Children . 
XII. Of Dentition .... 

XIII. Of the Diseases arising from Dentition 

Sect. I. Of Eruptions 

A — Crusta Lactea . 
B- 
1. 
2. 
3. 
4. 
5. 
Of Sore ears 

XIV. Of Tongue-Tie 

1. Of the Adventitious Tying of the Tongue 

2. Of the Original Conformation of the Fraenui 

rendering the Tongue too short . 

3. Of the Swallowing of the Tongue and Hemo 

rhage ...... 



Tooth Rashes . 

Strophulus Confertus 
" Intertinctus 

" Albidus 

" Volaticus 

" Candidus 



241 
247 
252 
253 
257 
263 
265 
272 
275 
280 

281 
283 
290 
291 
291 
296 
297 
297 
299 
299 
300 
300 
302 
303 

303 

304 



XVI 



TABLE OF CONTENTS 



Chap. XV. 
XVI. 


Of Bleeding from the Navel-string 

Of Ulceration, or Imperfect Healing of the Navel. 




Treatment in the First Situation 




Second Situation 








Third Situation 






XVII. 
XVIII. 


Of Hydrocele .... 
Of Umbilical Hernia . 






XIX. 


Of Inguinal Hernia 






XX. 


Of Abscess of the Hip Joint 






XXI. 


Of Abscess within the Ear . 






XXII. 


Of Adhesion of the Labia Pudendi 






XXIII. 


Of Diabetes .... 






XXIV. 


Of Incontinence of Urine . 






XXV. 


Of Constipation .... 






XXVI. 


Of Vomiting .... 






XXVII. 


Sect. I. Idiopathic . 

II. Sympathetic 
Of Diarrhoea .... 
Sect. I. Feculent 

11. Bilious .... 

III. Mucous 

IV. Chylous .... 
V. Lienteric .... 

VI. Chronic Form of Diarrhoea 
VII. Of the Treatment 






XXVIII. 


Of Cholera Infantum .... 






XXIX. 
XXX. 


Of Whooping-Cough . 
Of Cynanche Tonsillaris 






XXXI. 


Of Cynanche Parotidae, or Mumps 






XXXII. 


Of Croup . . 






XXXIII. 


Of Worms 


. 






XXXIV. 
XXXV. 


Of Scarlet Fever 
Of Measles 


• 






XXXVI. 
XXXVII. 


Of Nettle Rash . 
Of Burns . 


• 






XXXVIII. 


Of Prolapsus Ani 


, 






XXXIX. 


Of the Whitlow 


. • 






XL. 
XLI. 


Of Discharges from the Vagina . 
Of Scurfiness of the Head . 








A Translation of-th 
A Glossary for Ex- 
Index 


e Prescriptions . 
plaining Technic 


alTei 


•IDS . 



OF THE 



PHYSICAL TREATMENT 



OF 



CHILDREN. 



BOOK I.-PART I 



CHAPTER I. 

OF MARRIAGE. 

1. Before we detail the duties of the married woman, either 
as regards herself, or the treatment of her children, we feel it 
proper to say a few words upon the subject of marriage, as it 
must have a strong bearing upon the health of offspring. We 
shall consider this subject under the following heads: — First, the 
most proper period to both sexes for its consummation ; Second- 
ly, the respective constitutions of the individuals ; Thirdly, their 
disposition to disease ; Fourthly, their immediate state of health. 



Sect. I. — Period of Life. 

2. It is notorious, that the development of the body is suc- 
cessive, and requires a definite period for its completion ; conse- 
quently, certain functions cannot be performed, in the best man- 
ner, until full development — this rule applies as well to the 
female, as to the male. It is also familiar to observation, that 
when any viscus is prematurely or inordinately urged to action, 
that it is followed by the imperfection of the product dependent 
upon the part thus stimulated, as well as entails upon the organ 
so exercised debility, if not premature decay. 

3. From this it will follow, that too early marriage is never 
to be advocated ; since it will materially influence the health and 
well being of offspring. This fact is no less conspicuous in the 

2 



18 



OF MARRIAGE, 



inferior animals, than it is certain in its consequences in man. 
We would, therefore, not only say, that marriage should not 
take place until the body is healthily and completely developed, 
but also that there should have been, on the part of the male, 
the most scrupulous continency, that the great object of marriage, 
(the propagation of healthy children,) should not be defeated: 
this cannot be too strongly insisted upon, however little it may 
be availing. The female is always supposed to be so after the 
establishment of the catamenia, the enlargement of the breasts, 
and general development of the body. 

4. It would be difficult to rigorously fix the period, by years, 
at which the body becomes fully expanded: since, original stamina, 
physical and moral education, climate, mode of life, &c. will have 
their influence ; but we may with much certainty fix it, in this 
climate, at between the twenty-third and twenty-fifth years, for 
the male ; and from the nineteenth to the twenty-first years, for 
the female. 1 We are informed by Tacitus that the ancient 
Germans never married until the twenty-fourth or twenty-fifth 
year of their age, and were as continent, before its consummation, 
as the females to whom they were united ; in consequence of 
which, they acquired a size and strength that excited the asto- 
nishment of even the Romans. 

5. It has frequently excited the surprise, as well as provoked 
the reproach of foreigners, that the females of this country lose 
their beauty so early, especially when compared with the females 
of Europe, and particularly those of Great Britain. The cause 
of this hasty decay must be principally sought for in our very 
early, or rather premature marriages ; but we confess that climate 
has also a certain, though a more limited agency. Though we 
are far from discouraging early marriages, yet we are decidedly 
opposed to premature ones. By early marriage we would wish 



' The following curious table, constructed by Dr. Granville from an examina- 
tion of eight hundred and seventy-six cases in lying-in hospitals, &c, is the first 
ever submitted to females to exhibit their chances of marriage at various ages. 



Years of 


age. 


3 


at 


13 


11 


at 


14 


16 


at 


15 


43 


at 


16 


45 


at 


17 


67 


at 


18 


115 


at 


19 


118 


at 


'20 


86 


at 


21 



Years of 


age. 


85 


at 


22 


59 


at 


23 


53 


at 


24 


36 


at 


25 


24 


at 


2d 


28 


at 


27 


22 


at 


28 


17 


at 


29 



9 at 30 



Years of age. 

7 at 31 

at 32 

at 33 

at 34 

at 35 

at 36 

at 37- 

at 38 



1 at 39 



It is a curious fact, that if a woman marry at' twenty-one or twenty-two, and 
is placed under precisely similar circumstances, for the following fifteen years, 
as women at fourteen, fifteen and nineteen, marrying at that age, may be supposed 
to be under, she will produce the same number of children as the latter would, 
though the party marry eight years later. 



PERIOD OF LIFE. 19 

to be understood, such as may take place so soon as the body has 
received its final expansion ; and that time, we have just fixed, 
as a general rule, at nineteen, or a little more, for the female ; 
and twenty-three, and a little upwards, for the male. By pre- 
mature ones, we mean those which happen before the system has 
received its ultimate development, be this period when it may; 1 
— and this should be the more insisted on, as it would appear, 
from the calculations of Dr. Granville, in the note just referred 
to, that neither the woman herself nor society lose by a proper 
delay — so that it is best to do so, both morally and politically. 

6. It will readily be seen, that no precise or absolute rules 
based upon the lapse of years, can be laid down; since the body 
of both male and female may be precociously expanded, or may 
be unusually morbidly retarded. In the first instance, the period 
we have assigned may be anticipated with safety; but in the 
second, it would be wise to extend it. Thus, oftentimes in India, 
females become mothers at ten; while in Lapland they rarely 
give evidence of womanhood until eighteen; consequently, the 
women of India would be on the wane, did they wait for the limit 
at which it would be proper for a Lapland woman to marry ; and 
the Lapland woman could not support the contingencies of mar- 
riage, did she attempt to regulate it by the usage of India. 

7. The evil consequences resulting from precocious unions in 
this country are familiar to every body — they are not limited 
to the diminished vigour and shortened life of the male ; nor to 
the faded beauty, the blasted health, and the premature old 
age of the female; but are extended to their innocent offspring, 
on whom they have perhaps entailed a diminutive stature, debility 
of body, and imbecility of mind; or have handed down to them 
strong predisposition to consumption, rickets, scrofula, &c. It 
is, therefore, of the utmost consequence that parents do not con- 
sign their children to inevitable ill health, by consenting, or 
sometimes by urging them to too early marriages ; and on the 
part of the children themselves, that they do not yield them- 
selves up to almost inevitable destruction, (especially the female,) 
by anticipating the eligible moment for marriage consummation. 

8. We are, however, strong advocates for early marriages, 
(agreeably to our definition of them ;) we are persuaded of the 
importance of both their moral and political tendency; and we 
think they should be encouraged, wherever there is a rational 
expectation of both these great ends being answered. 

9. The consequences of ill-assorted marriages were well known 

1 This should not be confounded with the mere growth of the body, for we have 
seen instances where the osseous and muscular system has been unusually early 
developed, while the uterine has been very imperfectly so — hence, the error of 
confounding the necessity of its functions with the ordinary development of other 
parts of the body. See Treatise on the Diseases of Females, art. ii Amenorrkaa,.'' > 



20 OF MARRIAGE. 

to the ancients, and were strictly forbidden by the Greek legis- 
lators; and though things have not proceeded to such length in 
this country as to require the interference of the laws, it is never- 
theless sufficiently common to make a caution upon the point 
proper. Should no attention be paid to compatibility, the ob- 
vious and most desirable objects of marriage will be defeated, 
and one great source of health and longevity destroyed; for it is 
a fact, no less important than well established, that a well regu- 
lated marriage contributes largely to these two great ends. It 
is declared by Huffland that all those who have attained great 
age were married even more than once, and generally at a late 
period of life ; and that there is no instance of a bachelor attain- 
ing a great age. We may give two remarkable instances of 
longevity, where marriage was often repeated: one in Thomas 
Parr, of England, who attained to one hundred and fifty-two 
years, and was married several times : and the other in De Long- 
ville, of France, who lived until he was one hundred and ten 
years old, and married ten wives: his last he married in his 
ninety-ninth year, and she bore him a son when he was in his 
hundred and first. 

10. It seems agreeable to all observation, that better consti- 
tutions are perpetuated to offspring by men advanced in life, 
where the physical powers have been well preserved by moderate 
and proper use, than by young men who have been prodigal of 
them ; for it is oftentimes better to be old in years than in con- 
stitution. 

11. Though we have said that men advanced in life may have 
healthier offspring than the man who too early tests his prowess, 
or the one who has been too prodigal of his powers, we are not 
advocates for the union of old age to blooming youth. On the 
contrary, we are entirely convinced, that none so completely 
fulfil their duties to society, as those who unite themselves as 
soon as the proper development of body, and well established 
health, will justify their union. Yet we are equally persuaded 
of the truth of what we have just observed ; namely, that a man 
advanced in years may have every requisite firmness of consti- 
tution to justify a union; while a young man, who may have a 
natural feebleness of constitution, a strong predisposition to dis- 
ease, or its actual existence, or a debility from overtaxed powers, 
may be altogether ineligible to such a consummation. 



Sect. II. — Of Constitution. 

12. It is not alone sufficient, for the best purposes of mar- 
riage, that the body has received its final development, either on 
the part of the male or the female; since all the functions of 



PREDISPOSITION TO DISEASE. 21 

the body may be disturbed, by either feeble organization, dis- 
ease, or accident. When, then, the male and female, or either, 
has suffered in constitution, it is not to be expected they can 
impart to offspring that which they themselves do not possess. 
It should, therefore, always be a consideration in a marriage 
contract, that both parties be of sound health and constitution. 
13. We are aware in many instances it may be said, that hale, 
healthy-looking children belong to parents of feeble constitution : 
but we must be cautious how we admit this as militating against 
our position ; since such appearances are by no means conclusive 
of the goodness of health or the soundness of constitution. We 
have many times seen children of robust appearance from pa- 
rents of feeble health; but we do not recollect a single instance 
where such children attained an age much beyond manhood — 
old age was out of the question. Indeed, it would seem, in many 
instances, that children of such parents most frequently give an 
early promise of future health ; but it is illusory — as it is never 
or but very rarely realized. Like fruit that attains its maturity 
prematurely, it looks fair to the eye ; but cancer is lurking at 
the core. In the early part of the lives of the children of whom 
we are now speaking, a rapid, but morbid development of the 
body takes place ; every function is inordinately performed ; and 
when the constitution is confirmed in appearance by such a dis- 
play of health, it is but hastening to decay. Let us not then 
be deceived by such appearances ; and when we are choosing for 
our children, let us select such as give a rational reliance upon 
the soundness of their constitutions. 



Sect. III. — Predisposition to Disease. 

14. There are numerous diseases, or rather a disposition to 
them, which do not show themselves for many years after birth, 
or until they are called into action by some exciting cause, either 
suddenly or gradually applied ; such diseases are gout, madness, 
scrofula, consumption, &c. Those who may inherit such predis- 
positions may for many years enjoy good health; and may not 
be led to suspect a cause to be lurking in their systems, which, 
when called into action, shall, but too soon, destroy such flatter- 
ing expectations. It therefore becomes a point of duty in pa- 
rents to investigate the tendency to hereditary complaints, be- 
fore they connect their children with those who can give but a 
temporary security against the most painful, afflicting, irremedi- 
able, or suddenly fatal diseases. 

15. We hold it selfish at least, if not dishonest, for either sex 
to marry under such predispositions, when, from the knowledge 
of the diseases of their forefathers, there was every reason to 



22 OF MARRIAGE. 

anticipate a perpetuation of them. Who has not witnessed the 
most deplorable consequences of such unions? — and who, after 
witnessing them, would not deprecate their continuance, or 
farther propagation ? This subject is one of much importance ; 
for some of the best interests of society are involved in it ; and 
every one is concerned in diminishing the evils spoken of, by 
preventing marriages which can promise nothing but the exten- 
sion of the most dreadful diseases. 1 We have seen but too many 
instances of the perpetuation of the maladies above enumerated, 
not to feel desirous to arrest them, by recommending the two 
only means by which they can be either prevented or mitigated ; 
namely, by judicious and well-assorted marriages, and a well- 
conducted physical education. 

16. By the first means, we may stop, in a great measure, the 
hereditary transmission of predisposition, by selecting such sub- 
jects as shall be free from constitutional taint; or, at least, we 
may diminish by this plan the risk of such occurrence, if we 
cannot insure exemption from it. We may also do much good 
by preventing altogether the union of such as may have these 
tendencies; or diminish the evils in a degree, when nothing 
better can be done, by not admitting to this union more than 
one of a party who may have hereditary taints. 

17. By the second, much may be effected by invigorating the 
general system, so as to render it less susceptible to exciting 
causes : by attention, while conducting this education, to strength- 
en the particular parts which may be predisposed to disease. 
But of this more by and by. 



Sect. IV. — Of the Immediate State of Health. 

18. By the immediate or actual state of health, we would wish 
to be understood, that condition of the system in which either 
of the above named diseases is absolutely developed. It might, 
at first sight, appear strange, that we should notice this state of 
the system; as every one would seem to be apprized of it, and, 
consequently, the person labouring under it would not be con- 

1 We have been much pleased with the observations of Dr. Reid upon this im- 
portant point, as they convey and enforce our own sentiments. "Nothing can 
be more obvious, than that one who is aware of a decided bias in his own person 
towards mental derangement, should shun the chance of extending, and of per- 
petuating, without any assignable limit, the ravages of so dreadful a calamity. 
No rites, however holy, can, under such circumstances, consecrate the conjugal 
union. In a case like this, marriage itself is a transgression of morality. A man 
who is so situated, in incurring the risk of becoming a parent, involves himself 
in a crime, which may not improbably project its lengthened shadow, a shadow 
too which widens in proportion as it advances over the intellect, and the happi- 
ness of an indefinite succession of beings." — Med. Chirur. Rev. for July, 1830, 
p. 90. 



IMMEDIATE STATE OF HEALTH. 23 

sidered eligible by any one, for the married state. But this is 
not exactly so ; as we find that every kind of artifice is resorted 
to, to hide this condition from those most interested in the know- 
ledge of it, — hence, the frequency of marriages under such cir- 
cumstances. 

19. Besides, it but too frequently happens, that this fore- 
knowledge is entirely disregarded by the persons most concerned 
— this may arise from several causes; First, a want of proper 
feeling for the consequences of such diseases, when extended to 
offspring; Secondly, a hope of an escape from their conse- 
quences, as sometimes happens ; Thirdly, an ignorance of their 
nature, and of the risk of their propagation; Fourthly, a dis- 
graceful selfishness, where fortune or beauty is concerned. 

20. In Europe, they have such dread of the perpetuation of 
these diseases, (with, perhaps, the exception of gout,) that the 
inquiry is frequently made, in the higher ranks of society, before 
the marriage contract is signed, whether either of these diseases 
actually exists, or whether the parties be liable to them by here- 
ditary descent ; and we are informed that marriages have been 
frequently broken off, and even at a late period, when it was dis- 
covered on the side of either party, that scrofula, consumption, 
or madness, had existed, or was actually existing, in any mem- 
ber of the family. 

21. It is not, however, predisposition to disease, or its actual 
existence, that exclusively disqualifies the parties for marriage 
— or that may entail feebleness of body or mind upon off- 
spring ; for there are others, equally certain, though less noto- 
rious to common observation ; such are the habits of general dis- 
sipation, or habitual intoxication. The first appears to have 
most effect upon the body, the latter upon the mind; therefore, 
a woman should not unite herself to a man who labours under 
either, if it be known ; and the laws should protect her by grant- 
ing a divorce, if it occur after. 

22. In this country, the vice of intoxication is more common 
than in any other; but, unfortunately for the poor female, it 
but too often occurs only after marriage; and against this the 
laws make no provision — she is then doomed, in her own person, 
to all the horrors which await the vice ; and her children are to 
be the inheritors of feeble constitutions: or, what is perhaps 
worse, the predisposition to derangement of mind, or the per- 
petuation of the same vice. 

23. On the part of the female, certain physical disabilities 
may exist, which would render her ineligible for the married 
state : these should neither be concealed, nor passed over slightly; 
since, with a knowledge of them, it would be dishonest towards 
the man she may marry, as well as fatal to herself. We would, 
therefore, recommend to a woman who may be deformed to ab- 



24 OF MARRIAGE. 

stain from marriage, as she may purchase the title of wife at 
too high a price; and we would advise such as may be disposed 
to cancerous affections, or such as may have one in an active 
state, to refrain from this state, as she can promise herself no 
advantage from this ceremony, as regards the melioration of her 
disease ; for with it she will linger through continued ill health 
and pain, become a source of misery and expense to a husband, 
whose patience and resources may too easily be exhausted, and 
thus fall an earlier victim to disease alone. 

24. We would also recommend the female not to put off this 
ceremony to too late a period of life, when she can with pro- 
priety do otherwise ; unless she be content to endure more than 
ordinary suffering from child-bearing, and become regardless of 
the pleasure of seeing her children settled in life before she 
leaves the world, by even the common contingency of age. 
Women who have passed the thirty-fifth year of life, might, per- 
haps, do best to permit the period of child-bearing to pass before 
they marry. (See par. 4, 5.) 

25. Upon the same principle, in part, would we caution the 
very young girl not to enter into this state ; as she, like the wo- 
man who may have waited too long, is liable to severe suffering 
from labour. In the woman too far advanced, the parts con- 
cerned in parturition seem to forget, in a degree, their offices; 
while, in the too young female, they have not entirely or per- 
fectly acquired the capacity. It is lamentable to see the num- 
ber of sacrifices of this kind: we have seen but too many females 
marry at fifteen or sixteen, become mothers at great hazard, 
and their career of life run at thirty years. They die of pre- 
mature old age, at this early period. These facts are too well 
known to be disputed ; and nature seems to have contended for her 
prerogative in both instances. Shall we then become voluntarily 
blind, by shutting our eyes against her obvious intentions ? Do 
not these facts emphatically declare there is a time best fitted 
for marriage ? This time we shall fix at nineteen for the earliest, 
and thirty for the latest best periods. (Par. 4, 5.) 

26. We do not, however, mean to say, the period fixed for the 
earliest may not, without any very great risk, be anticipated a 
little ; or that the second may not safely be exceeded — we mean 
merely to insist, that the periods just designated are best as 
general rules; for it is but general rules we can lay down upon 
this subject. 



OP THE CONDUCT OF THE MOTHER, ETC., 25 



CHAPTER II. 

OF THE CONDUCT OF THE MOTHER DURING PREGNANCY. 

27. When we consider the delicacy and uncertainty of the 
attachment between the ovum and the uterus in the early months 
of pregnancy, and the facility with which this union may be 
destroyed, we cease to wonder that abortion should so frequently 
take place; but, at the same time, we are taught to acknowledge 
the care that is required for its prevention. 

28. Could we excite in the female a proper dread of this acci- 
dent and its consequences, by representing the facility of recur- 
rence ; the difficulty of interrupting its course when a habit is 
established ; and the terrible train of evils in its suite, we should 
make her careful how she incurred the risk to which so severe a 
penalty is attached. 

29. Should she, however, disregard the physical evils which 
so uniformly attend habitual abortion, and set at naught mere 
bodily suffering, she surely could not resist the appeal which a 
neglect of proper care constantly makes to her moral sense: she 
would most certainly question her right to destroy the fruit of 
a union she is bound to hold sacred, by conduct of her own, 
when it was completely in her power to have prevented abortion 
by the observance of a few rules, which neither require severe 
privations, nor very rigid conformities. 

30. To us, who are familiar with the consequences which follow 
repeated abortion, it is truly a matter of surprise, mingled with 
regret, that females should so entirely shut their eyes against 
them, and brave the evils, numerous and serious as they are, 
rather than submit to a properly regulated plan for the inter- 
ruption of their progress, or to avoid the causes which may produce 
them. We have but too often seen the fairest promises of health 
and long life blasted, by disregarding the friendly warnings a 
first or second accident of this kind had given ; and we feel it 
an imperious duty to proclaim the nature of those evils which 
are sure sooner or later to follow, in hope it may awaken the 
female to a sense of her danger, and excite her to a due regard 
for her future welfare. 

31. To the fine lady by profession, we are well aware this 
appeal would be in vain ; or at least, it will not challenge her 
attention, until her health is either about to be destroyed, or 
very seriously injured ; or when there is but an uncertain chance 
of recovery. 



26 OF THE CONDUCT OF THE MOTHER 

82. The consequences of repeated abortion are, first, a bad 
state of leucorrhoea; secondly, immoderate flow of the catamenia, 
attended very often by the expulsion of coagula; their too fre- 
quent returns ; or that distressing condition of this discharge 
called dysmenorrhea, or painful menstruation ; thirdly, dyspep- 
sia, with all its terrible penalties ; fourthly, scirrhi and cancers ; 
besides many other evils of minor importance. The catalogue 
here exhibited is not the sportings of the imagination ; it has 
but too real a foundation, as every practitioner of experience 
can safely testify. 

33. To prevent the consequences above stated, (32,) the preg- 
nant woman must scrupulously avoid, 1st, such motion as shall 
unduly exercise her muscles; as too long walks, especially in 
such w T eather as will endanger her falling ; or as shall overheat 
her, as dancing in very hot weather ; hastily running up stairs ; 
lifting heavy weights, &c. ; 2d, all such as shall take her mind 
by surprise, if we may so term it, as unpleasant or dangerous 
sights ; 3d, all such as shall inordinately hurry her circulation, 
as heated rooms, or stimulating liquors, &c. ; 4th, all such as 
shall embarrass the intestinal canal, or too severely tax the powers 
of the stomach; as flatulent vegetables, too great a quantity 
even of proper food, or any quantity taken at improper seasons, 
as late suppers, &c. ; 5th, all such as shall give too frequent 
motion to the bowels; as brisk or drastic purgatives; or such as 
shall too much retard their motion, as the unnecessary use of 
laudanum, or the unnatural use of chalk, or disobeying the proper 
calls of nature, &c. ; 6th, all such as shall make too severe and 
partial a pressure upon the chest and abdomen, as tight lacing, 
&c. ; 7th, all such as shall increase the irritability of the system; 
as the immoderate use of strong tea, coffee, opium or other nar- 
cotics ; and the too long indulgence of repose in warm feather 
beds ; 8th, all such as shall too exclusively occupy the mind ; as 
severe study, night w r atching, &c. &c. 

34. But let not the mother believe she completely discharges 
her duty, or that she gives the best possible chance to her off- 
spring, by merely escaping from a miscarriage. In this opinion 
she would certainly not be supported either by facts or reasoning ; 
for it is well known to those who are best acquainted with the 
subject, that the proper circulation and nutrition of the foetus, 
may, by the improper or heedless conduct of the mother, be 
impaired, though the foetus itself may not be destroyed. Of 
this we have abundant proof in the cases of those who narrowly 
escape from this accident, and who have had repeated threaten- 
ings; therefore it behooves her, as a rational and an accountable 
being, as far as possible, to avoid every risk of provoking abor- 
tion. She must not flatter herself, because she has not miscar- 



DURING PREGNANCY. 27 

vied, that she has done no injury to the fruit of her womb. How 
many instances can almost every mother call to mind, of off- 
spring born feeble and emaciated, and continued to be so, or 
with difficulty recovered, when the cause might be traced to 
some impropriety of conduct on the part of the parent, or to 
some accident during the period of utero-gestation, which might 
have been prevented? 

35. We are well persuaded, that much injury has been done 
by the prevalence of certain' vulgar errors upon this subject; 
some of which it may be well to examine. It has been handed 
down from time immemorial, that pregnancy was constantly 
accompanied by a plethoric condition of the blood vessels, and 
that, consequently, there was a recurring necessity for blood- 
letting. And practice has very constantly been made to conform 
to this hypothesis by the ignorant or designing, and sometimes 
to the very serious injury of the patient. It is, however, our 
deliberate opinion, that this state of fulness does not always 
exist ; and when it does, it by no means follows that it should 
always be subdued by bleeding. 

36. We are warranted by long experience to declare, that 
unless this plethora produce some direct evidence of a mischie- 
vous tendency, as headache, pain in the chest, a sense of fulness 
in the head upon stooping, giddiness, &c, the patient should 
not have recourse to bleeding, without the express approbation 
of the physician. And perhaps it would be erring on the safe 
side to say, that even where the symptoms just enumerated are 
present, his advice had always better be asked. 

37. To women who are in the habit of miscarrying, this pro- 
scription of indiscriminate bleeding is particularly important: 
especially as it is the remedy almost universally resorted to for 
its relief; than which, in very many instances, nothing can be 
more preposterous or improper. We know ourselves to be justi- 
fied in saying it has very often produced the evil it was intended 
to prevent. 

38. We are happy to avail ourselves of the opinion of the 
celebrated Dr. Struve upon this point; and shall quote his own 
words: "Many erroneously imagine that blood-letting is useful 
during pregnancy; hence, mercenary bleeders and imprudent 
midwives contribute to support that ill-founded opinion. It is, 
however, certain that venesection is a remedy which ought not 
to be resorted to, without the greatest precaution, as the loss of 
blood may precipitate a pregnant woman into many dangerous 
diseases, and even occasion miscarriage. Instances of this kind 
have occurred in my own practice; and I have known ladies who 
have unfortunately been subject to successive abortions, because, 
by the advice of their friends, they regularly submitted to be 
bled upon such occasions. On their becoming pregnant again, 



28 OF THE CONDUCT OF THE MOTHER 

I warned them of the mischief resulting from this practice, and 
they now enjoy the happiness of being mothers." 1 

39. We admit, without hesitation, that there is a strong ten- 
dency to fever and fulness during gestation, when there is any 
cause in operation which may be capable of exciting the system 
to unusual action, or of filling the blood vessels in an unusual 
degree ; and it was under this impression that we recommended 
the cautions suggested above, (33.) For we are fully persuaded, 
that, for the most part, a proper observance of the rules just 
referred to will very frequently render blood-letting unnecessary ; 
nay, nature institutes nausea and vomiting to keep down this 
excessive fulness. 

40. It must not be inferred, however, from what has just been 
said, that we are hostile to blood-letting — this is very far from 
being the case; we consider ourselves among its warmest advo- 
cates, if a necessity for its employment really exist: it is against 
its abuse alone that we contend. We attach great value to this 
operation where there is evidence of its necessity; and believe 
it oftentimes capable of affording relief, where no other remedy, 
perhaps, would avail; but of this necessity the experienced and 
judicious physician should be the only judge ; it should not be 
left to the decision of every old woman. 

41. From what has just been said, it will appear, that it is 
not our opinion that pregnancy necessarily renders the use of 
the lancet proper — it is a vulgar error to suppose so: and as this 
remedy is sometimes resorted to solely because impregnation 
has taken place, and this, as stated above (35, 36, 37,) with 
manifest injury, the sooner this error is corrected the better. 
We have a hundred times refused our assent to this operation, 
because there was no one reason for its being resorted to, save 
that the woman was pregnant. Under such circumstances, it is 
but little in its favour to say it can do no harm — but even to this 
trifling recommendation it is not always entitled; for we can 
most safely declare, we have frequently known it do serious and 
sometimes irreparable mischief. 

42. There is another error of no less moment than the one 
just combated, and which should also be corrected — namely, the 
free indulgence of a wayward or voracious appetite, because 
the woman is pregnant: and because, according to common par- 
lance, she has a child within her to support. This error, or pre- 
judice, in favour of eating largely during pregnancy for the sup- 
port of the child, is almost constantly at variance with the laws 
which govern the system at this time. For it almost constantly 
happens that there is a genuine antipathy to animal food during 
gestation ; and if taken it is almost sure to disagree with the 

1 Treatise on Physical Education, p. 169. 



DURING PREGNANCY. 29 

patient, and it is hardly fair to suppose, that a substance which 
disagrees with the mother will be necessary or acceptable to the 
child. We have often heard this reason given by females, who 
avail themselves of this condition to gratify their appetites for 
food, without the smallest regard to consequences. Indigestion, 
colic, cholera morbus, and even convulsions, have been too often 
the melancholy consequences of such indulgence. 

43. As this error originates in theory, or hypothesis, it may 
be well to examine its pretensions ; and if we can show that there 
is no absolute necessity for taking more food than ordinary, we 
shall be, perhaps, more able to do away the practice. 

44. The demands which the foetus makes upon the mother for 
the means of its increase, is in proportion to the time of its con- 
tinuance within the uterus. Now, if we average the weight of 
new-born children, eight pounds would be excessive for each. 1 
But, we will assume it to be such : this, of course will give one 
hundred and twenty-eight ounces; the placenta, and membranes, 
may yield one pound more, and the liquor amnii as much; the 
account will then stand thus : — 

Foetus — 8 lbs. or 128 ounces. 

Placenta, and membranes, . . 16 do. 
Liquor Amnii, 16 do. 

Total, 160 oz., or 10 lbs;— 
which will make a daily average demand of less than three- 
fourths of an ounce, since it requires about two hundred and 
eighty days for the perfection of the child: now, this quantity 
is every way too small to require an increase of ingesta, if the 
quantity taken each day were absolutely and duly weighed; 
since it is well known to every one, that we habitually take 
more food into our stomach, than is strictly required for the 
nourishment of the body, 2 and, of course, the woman can spare 

1 The average we have taken is excessive, perhaps, even for this country, hut 
decidedly so for Europe. — In France, or rather in Paris, at L'Hospice de la Ma- 
ternite, the following table will show a much smaller average in seven thousand 
and seventy-seven cases, viz. 



34 weighl 


: fror 


Q 1 


pound 


to 1| pound 


69 


u 


it 


2 


do. 


to 2£ do. 


164 


a 


te 


3 


do. 


to 3£ do. 


396 


a 


a 


4 


do. 


to 4| do. 


1317 


a 


tt 


5 


do. 


to 5f do. 


2799 


tt 


a 


6 


do. 


to H do. 


1750 


a 


a 


7 


do. 


to i\ do. 


463 


a 


tt 


8 


do. 


to 8l do. 


82 


it 


~tt 


9 


do. 


to 9* do. 


3 


a 


a 


10 


do. 


to!0£ do. 



Making an average of little more than six pounds. 

a To show how very much more is taken into the stomach than is required for 
the purposes of the system, we will extract a note from Friedlander's PEducation 
Physique de PHomme, p. 130. "I was informed," says Mr. Friedlander, "by 



30 OF THE CONDUCT OF THE MOTHER 

daily, without the slightest disadvantage, the quantity of food 
necessary to furnish three-quarters of an ounce of blood to be 
applied to the immediate purpose of the foetus ; or, in other words, 
the woman could furnish daily this quantity of blood for the pur- 
poses of the child, without feeling the demand to be oppressive; 
consequently, she cannot require a freer indulgence in food. 

45. Besides, what does nature herself dictate upon this sub- 
ject? Let us see if she really do not solicit a reduction of the 
quantity of food, rather than ask for an increase of it. — What 
happens to almost every woman very soon after impregnation 
has taken place? Nausea and vomiting. Now, do these not 
most emphatically declare, that the system requires reduction, 
rather than an increase of fluids? or why should this subduing 
process be instituted? It certainly cannot be intended for any 
other purpose, since it is not only almost universal, but highly 
important when it occurs, as it would seem to add much to the 
security of the foetus ; for it is a remark, as familiar as it is well- 
grounded, that very sick women rarely miscarry — while, on the 
contrary, women of very full habits are disposed to abortion, if 
exempt from this severe, but, as it would seem, important pro- 
cess. 

46. While on the present subject it may be thought incumbent 
that we should say a few words upon that whimsical demand, or 
"longing," for certain substances, the reality of which desire 
has been doubted by many. No man, however, of experience, 
we think, will for a moment deny, that, during pregnancy, there 
exists occasionally the most wayward appetite, and that even to 
the extent to which it is said sometimes to urge the unhappy 
patient. 

47. As regards ourselves, we are entirely convinced of its ex- 
istence; though we are not altogether prepared to determine the 
advantages of its gratification, or the evils which might arise 
from disappointment. We are certainly in possession of some 
remarkable facts upon this head; and, in many instances, where 
it could not be construed into an attempt to procure " the good 
things of this world " by sinister means. If women who are go- 
verned by this hallucination of the stomach, were always to de- 
mand the most grateful or savoury food, there might be some 
room to suspect the employment of stratagem. But when this 
morbid and fastidious appetite sometimes demands for its grati- 
fication the most disgusting and forbidding articles, we must 

the senator Moscati that he gave a large dinner one day, and had, as a matter of 
curiosity, every article of the dinner weighed; and he found that one great eater 
had destroyed one hundred and ten ounces, and that an ordinary feeder had eaten 
eighty-four ounces." These experiments were made at Milan; he supposes not 
with the utmost exactitude; but they show, with great certainty, that very much 
more is taken than can possibly be required for the purpose of nourishment. 



DURING PREGNANCY. 31 

yield to the belief of the positive existence of " longings." We 
pretend not to account for this peculiar condition of stomach — 
we know it only as an attendant upon pregnancy ; and will illus- 
trate it by detailing some remarkable instances of it. 1 

48. Mrs. , when not pregnant, had a great horror of eels : 

but, when in this situation, demanded them with an importunity 
not to be resisted. She, therefore, would not only eat them with 
avidity, but in large and repeated quantities, for the first few 
months ; she would then become indifferent to them, but not 
averse, until after her delivery. 

49. Mrs. , riding over a common, scented some spoiled 

shad, that had been thrown out; she was instantly so fascinated 
by their odour, that she obliged her husband to take some of them 
into his gig; and as soon as she arrived at home, began to eat of 
them, raw as they were, and continued to do so daily, until they 
were consumed, though they were extremely offensive to every 
body else in the house. 

50. Mrs. , in passing through her kitchen, saw a piece of 

bacon skin boiling in the soap kettle; she had it taken out im- 
mediately, and she ate it with great avidity. 

51. Each of the cases above stated, with the exception of the 
first, was related to us by the lady herself; in the first, we our- 
selves witnessed the eagerness with which the eels were eaten, 
and received the history of this lady's aversion to them, when 
not pregnant, from her own mouth. Of the truth of the others 
we have not the slightest doubt, as the ladies were of undoubted 
veracity. It is true, these are extreme cases; but they go to 
establish the existence of this peculiar appetite, and its indis- 
criminate, and, we may add of the last two, filthy selections. 
Instances of minor enormity are familiar to every body. 

52. In stating our belief in this peculiar, and indomitable 
craving of the stomach, we admit nothing in favour of the popu- 
lar opinion, that a disappointment in procuring the desired ar- 
ticle would be attended with any more serious consequences 
than would follow a disappointment of any other kind, at a period 
when the woman was not pregnant — it might, indeed, nay it 
very often does, occasion sickness at stomach, a temporary loss 
of appetite, and sometimes vomiting ; but here the evil ceases, as 
far as we have observed. 

53. Nor do we believe in the influence of the " imagination " 

1 We beg, however, that our opinion on this subject may not be construed into 
an attempt to foster or perpetuate that waywardness of appetite, or capriciousness 
of selection, of the more stimulating and piquant dishes which are so frequently 
indulged in by women when pregnant: we totally disclaim any design to counte- 
nance such contemptible stratagems, with aviewto exact compliance from an indul- 
gent husband, through the medium of his fears or his affections. The desires 
here alluded to have their origin in mere fastidiousness and affectation — those 
we believe in arise from the absolute cravings of a distempered stomach. 



32 OF THE INFLUENCE OF IMAGINATION 

upon either the form, colour, or future destiny of the child, how- 
ever powerfully this faculty may exert itself during gestation — 
we entirely reject all the reasoning, as well as the appeals to 
facts, purporting to be illustrative of this wonderful influence. 
We have, ever since our commencement in business, been atten- 
tive to this subject; and we can most conscientiously declare, we 
have never, in a single instance, had reason to believe that the 
imagination had exerted the slightest control upon the foetus 
in utero; though this is contrary to our early belief upon this 
subject. 

54. As we feel this to be a subject of high interest to the fe- 
male, we trust we shall be excused for occupying a few minutes 
in its consideration ; and the more especially, as we believe that 
when the mind is so tenaciously occupied upon the object of it3 
aversion (as we always find it is,) when an apprehension has been 
once excited, it may do mischief to the foetus, by impairing its 
pabulum during gestation, through the medium of the stomach or 
blood vessels, or both; and, hence, is connected with the "Phy- 
sical treatment of children." 



CHAPTER III. 

OF THE INFLUENCE OF IMAGINATION UPON THE FOETUS IN UTEHO. 

55. There is no delusion of the mind during pregnancy, that 
renders the woman so truly wretched as the belief that the ima- 
gination can exert an injurious control over her child. Should 
she have an ungratified longing; should she have been disagree- 
ably surprised, or greatly alarmed; or, above all, should she 
have been terrified by some frightful or disgusting object, she at 
once becomes possessed with the apprehension that her unborn 
babe will receive an injury or blemish, similar to that which had 
excited her aversion, or caused her alarm. She dwells upon 
this idea with such pertinacity that she becomes almost a victim 
to its influence. Her nightly "imaginings" are those of hor- 
ror ; and the day affords no relief, as her mind teems with pre- 
judices, which are in favour of an influence most earnestly depre- 
cated ; and nothing but the delivery of an unblemished child can 
soothe her agitated feelings, or remove her long-cherished fears. 

66. The origin of this belief, it is true, is coeval with our 
earliest records; but its antiquity should not entitle it to the 
least force, when this argument alone is employed; for were 
this to be a rule, there would be no end to error, however power- 



UPON THE F(ETUS IN UTERO. 33 

fully combated by reason, or opposed by facts. No one circum- 
stance connected with the history of this prejudice has so effec- 
tually contributed to its permanency, as the successful stratagem 
of Jacob, to secure to himself all the " ring-streaked " cattle 
from the flocks of Laban, as his reward for his faithful services 
to his selfish father-in-law, by placing before them when they 
were about to drink, "rods of poplar, and of hazel, and of 
chestnut trees," on which were pilled white streaks. Indeed, 
this may with much propriety be considered as the origin of this 
distressing illusion ; and it certainly is one on which the sticklers 
for this opinion chiefly rely, when strongly opposed by facts and 
reasoning. 

57. We are willing to give every credit to the fact of Laban's 
cattle becoming "streaked" by Jacob's scheme; as we may 
unreservedly believe in it, in that particular instance, without 
our standing committed to the belief that this effect continues 
to be perpetuated to this moment. In the case under consider- 
ation we are of the opinion, with many enlightened divines, that 
there was God's direct interposition in favour of Jacob, against 
the crafty Laban; since, as such means would not in general 
produce similar effects, it is more reasonable to suppose, that he 
was directed, (in the plan he adopted,) by some divine intima- 
tions, and rendered successful, if not by a direct miracle, yet by 
the Lord's giving a new and uncommon bias to the tendency of 
natural causes. Scott's Family Bible, Gen. Chap. XXX. And 
this supposition is rendered still more probable by what follows 
in verses, 10, 11, 12, and 13, of Chap. XXXI. 

58. If, then, we have rendered it more than probable that the 
hand of the Lord was in the effect produced by Jacob's mottled 
rods, we think that much of the feeling upon this subject should 
be abated, and the mind be permitted to listen to the suggestion 
of reason, and yield to the force of facts. 

59. To remove these apprehensions altogether from the minds 
of pregnant women, is perhaps impossible; for so fixed are their 
prejudices, and so cherished are their impressions upon this sub- 
ject, that it is no longer a matter of reason — it is one almost ex- 
clusively of feeling. Yet we flatter ourselves the force of this 
error may be diminished, though not entirely subdued, by argu- 
ments, based upon the solid foundations of anatomy and physi- 
ology, and from facts which deserve to be well weighed before 
they are rejected. 

60. In the infancy of medical science, the opinion that the 
imagination exerted an influence on the child in the womb, was 
implicitly received ; and Hippocrates himself assisted in the 
propagation of the delusion. It became not only a popular, but 
a fashionable belief; and kings and nobles, with the hope of 
realizing its efficacy, acted upon the principle ; and even when 

o 



34 OF THE INFLUENCE OF IMAGINATION 

certainly abused by their wives, they, nevertheless, credited its 
influence. It was made use of, (honestly we doubt not, at the 
time,) in some instances for the protection of the supposed inno- 
cent, against the severity of the law, or the indignation of an 
injured husband. Thus Hippocrates saved by his testimony a 
noble woman who had been charged, because she had borne a 
coloured child, (she and her husband both being white,) by al- 
leging that the darkness of its colour was the effect of a picture of 
an Ethiopian, which hung in her chamber, and which was often 
the object of her contemplation. 1 And Soranus declares that 
the tyrant Dionysius, who was deformed and ill-favoured himself, 
employed the aid of beautiful pictures, with the hope that his 
wife might have a comely issue. 2 

61. Galen was also of opinion that a picture was sufficient to 
give a corresponding appearance to the foetus in utero. And 
Caelius Rhodius informs us that Fabius Quintilian saved a woman 
from suspicion, after she had brought forth a little negro, by as- 
serting that the circumstance arose from her taking great plea- 
sure in viewing the picture of one in her chamber. 3 And it was 
from the prevalence of this popular belief, that Heliodorus formed 
the first, and, we may add, one of the most beautiful novels in 
the world. It is called the " Loves of Theagenes and Chari- 
clea;" the latter being born white from Ethiopian parents; but 
the Queen, her mother, had often viewed, during her pregnancy, 
the picture of Andromeda, who was painted with a white face : 
the sages attributed the white colour of the child to the force of 
the mother's imagination. 

. 62. Such notions upon this subject have existed from the ear- 
liest history of the world ; and such still continue to the present 
moment; but, with this exception: if cases like those related of 
Hippocrates and Quintilian were now to be presented for judicial 
decision, few juries would have sufficient hardihood to attribute 
the effect to the force of imagination; yet some not less marvel- 
lous and extraordinary stories gain full belief, at the present 
day, though not entitled to credit, in any superior degree. 

63. The different modes in which the imagination is supposed 
by its sticklers to affect the foetus are, 1st, by imposing upon 
its skin certain resemblances to things on which the fancy has 
been deeply concerned or employed ; such as fruit, wine, insects, 
or animals ; 2dly, by the production of additional parts, as two 
heads, four legs, additional fingers, toes, &c. &c. ; 3dly, by the 
absence or destruction of certain parts; as a leg, or arm, or 
both; the want of a head, or hand, or foot, or lip, &c. &c. 

64. The alleged effects of the imagination upon the foetus in 
utero manifest themselves in one of the three modes just named, 

1 Turner, p. 169. 3 Ibid. p. 170. 3 Ibid. p. 169. 



UPON THE FCETUS IN UTERO. 35 

(63.) We shall, therefore, say a few words upon each of these 
heads, respectively; and, first, we shall consider the nature of the 
connexion which exists between the mother and child, that our 
objections to the power of the imagination may be the better 
understood. 

66. Anatomy has most satisfactorily proved that the con- 
nexion between the mother and child is altogether indirect; 
and carried on only through the medium of the circulation. It 
has also shown there is no nervous communication between 
them ; or, in other words, that there has never been detected any 
nervous filament of the mother entering any portion of the 
foetal system. 1 From this wise and all-important arrangement, it 
follows that the foetus is not subject to the various and fluctuating 
conditions of the sanguiferous, or to the never-ending changes 
of the nervous system of the mother ; since no direct commu- 
nication exists between her blood vessels, or nerves, and those of 
the foetus, to impose upon it any alteration that may take place 
in her system, or to render the child liable, through the medium 
of nervous connexion, to her affections. 

* 6Q. If the arrangement be such as is now represented, and of 
the truth of which there cannot be a reasonable doubt, we may 
ask, how any condition of the arterial, or any affection of the 
brain and nervous system of the mother, can have an influence, 
or exert a control, over both these systems of the foetus, which 
has no direct connexion with the one, nor even an indirect one 
with the other? Were this arrangement between mother and 
child more closely studied, better understood, or more justly ap- 
preciated, we should hear much less of the influence of the 
imagination of the mother upon the body of her infant ; and one 
of the most agonizing conditions of the human mind would be 
removed from the list of evils attendant upon pregnancy. 

67. No one, so far as we know, has determined at what period 
of pregnancy the influence of the imagination ceases ; or, in 
other words, at which it cannot be successfully exerted — every 
period of utero-gestation, agreeably to the histories given to 
prove the powers of imagination, seems alike liable to its control. 
Now, this admission proves in many instances too much; for it 
not only gives to the fancy a generative power, but also an an- 
nihilating one. Thus, in some cases, an arm, a leg, a thumb, 
or a toe, is added to the child; while, in others, there is a loss 
of one of these parts. Who has ever detected the severed mem- 
ber, or part, escaping from the womb of the mother, at the birth 
of the mutilated child? Must this not have been observed, had 

1 Sir Everard Home may be cited in opposition to this assertion ; but we are of 
opinion that Sir E. stands alone in this belief: he certainly has not demonstrated 
them so as to satisfy any body but himself. 



36 OF THE INFLUENCE OF IMAGINATION 

the histories of such cases been a faithful relation of the influ- 
ence of the imagination ? 

68. Besides, it gives to this power another very extraordinary 
capacity ; namely, the stopping of the blood, after the part has 
been separated from the body, or limb ; for the child does not die of 
hemorrhage while in utero, but is absolutely born alive ! We once 
knew an instance where there was but the stump of an arm, 
which at the time of birth was perfectly healed, or rather disco- 
vered no evidence that it had ever been a wound; yet the mother, 
in this case, declared herself to have been frightened, at the 
sixth month of her pregnancy, by an impudent beggar, who was 
well known in this city. But what became of the lopped off 
arm ; — what arrested the bleeding ? We certainly did not dis- 
cover it ; nor had we any evidence that there had been a bleeding ; 
for the child was born healthy and vigorous; and no mixture of 
blood was discovered with the waters. Now, we must ask again, 
what became of the cast off arm ; or what arrested the bleeding ? 

69. Again, where resemblances have been supposed to be de- 
tected between the child and some animal by which the mother 
had been frightened, and this sometimes even at a pretty ad- 
vanced period of pregnancy, the power of the imagination must 
be very wonderful indeed, since, in order that the supposed effect 
should be produced, it must have new-modelled the head, though 
the bones of the cranium must have been pretty solid. Thus 7 
Bartholine * informs us, that in the year 1638, a woman was de- 
livered of a child in every way well shaped, except the head, 
which resembled that of a cat : this deformity was owing to a 
severe fright which the mother had received by a cat getting 
into her bed. In this famous case, if the point of resemblance 
to the animal by which the mother may have been frightened be 
admitted, it must also be acknowledged that the head of the 
child must have been remodelled by some plastic power of the 
imagination? a circumstance not to be acknowledged by reason, 
nor to be proved by fact — therefore this case, like many others 
we could cite, proves too much. 

70. We will not deny that instances occur occasionally of the 
perpetuation of supernumerary parts, or even marks, in certain 
families; such as an additional thumb, or toe, or finger, or a 
mole, but these cases are not the result of any exercise of the 
imagination — they are the mere continuance of peculiarity, such 
as of warts or blotches, the instances of which are numerous — 
but here the fancy has no agency in their production. 

Tl. We have been attentive to this subject, as already re- 
marked, for many years; and commenced our observations under 

1 Hist. Anat. Cent. 3, Hist. 44, as quoted b y Turner 



UPON THE F(ETUS IN UTERO. 37 

the full persuasion of the efficiency of imaginative influence, and 
abandoned it only because it could not be sustained by facts ; 
and, at this moment, we are entirely convinced that the fancy 
exerts no control whatever over the form of the foetus. 

72. We may mention here with much propriety, and we wish 
we could hope with as much effect, the opinion of the late cele- 
brated Dr. William Hunter upon this subject. Dr. Hunter used 
to declare in his lectures that he experimented in a lying-in hos- 
pital upon two thousand cases of labour, to ascertain this point. 
His method was as follows : — As soon as a woman was delivered, 
he inquired of her whether she had been disappointed in any 
object of her longing, and what that object was, if her answer 
were yes. Whether she had been surprised by any circumstance 
that had given her an unusual shock ; and of what that consisted. 
Whether she had been alarmed by any object of an unsightly 
kind; and what was that object. Then, after making a note of 
each of the declarations of the woman, either in the affirmative 
or negative, he carefully examined the child ; and he assured his 
class that he never, in a single instance of the two thousand, 
met with a coincidence. He met with blemishes when no cause 
was acknowledged ; and found none where it had been insisted on. 

73. It must, however, be confessed, that the Dr. owned he 
met with one case in his private practice that puzzled him ; and 
he told his pupils he would merely relate the facts, and leave 
them to draw their own conclusions. A lady had been married 
several years without proving pregnant; but at last she had the 
satisfaction to announce to her husband that she was in that 
situation. The joy of the husband was excessive, nay, unbounded ; 
and he immediately set about to qualify himself for the all-im- 
portant duty of educating his long-wished for offspring. He 
read much, and he studied Martinus Scribelerus with great pa- 
tience and supposed advantage, and he had become a complete 
convert to the supposed influence of the imagination upon the 
foetus in utero. He accordingly acted upon this principle. He 
guarded his wife, as far as in him lay, against any contingency 
that might affect the child she carried. He therefore, gratified 
all her longings most scrupulously; he never permitted her to 
exercise, but in a close carriage; and carefully removed from 
her view all unsightly objects. 

74. The term of gestation was at length completed; and the 
lady was safely delivered, by the skill of Dr. Hunter, of a living 
and healthy child; it had, however, one imperfection — it was a 
confirmed Mulatto. On this discovery being made, the father 
was at first inexorable; and was only appeased by his dutiful 
and sympathizing wife calling to his recollection the huge ugly 



38 OF THE INDULGENCE OF TEMPER, ETC. 

negro that stood near the carriage door the last time she took 
an airing, and at whom she was severely frightened ! 1 

75. Our limits do not permit us to do more ample justice to 
this subject, by employing additional arguments, or more nume- 
rous facts, to disprove the agency of the imagination upon the 
foetus in utero : we shall, therefore, dismiss it, and trust to what 
we have already said, to awaken the woman to reason, or at least 
to raise in her a rational doubt of the powers of the imagination 
over the fruit of her womb. We must now return to our gene- 
ral subject. 



CHAPTER IV. 

OF THE INDULGENCE AND EXERCISE OF TEMPER, ETC. 



76. Besides the prohibitions already suggested, there remains 
to be considered the injurious tendency of an indulgence in un- 
bridled passion upon the immediate as well as the future welfare 
of the foetus. The immediate evils which may result from yield- 
ing to temper are convulsions, nervous inquietudes, uterine 
hemorrhage, and, perhaps, abortion. Should this last not occur, 
the foetus may yet receive such injury as shall impair its natu- 
ral stamina, and thus entail upon it a feebleness of constitution 
as long as it may live. It is a remark long since made, and we 
believe it to be in perfect conformity with the fact, that pas- 
sionate and irritable women are more prone to abortion than 
those of an opposite temperament. This fact, alone, points out 
the necessity and importance of resisting those tendencies to 
anger, which may threaten the life of the mother, or jeopardize 
the welfare of the child. 

77. Nothing contributes more certainly to the safety and fu- 
ture good health of the child, than cheerfulness of mind ; or, at 
least, equanimity on the part of the mother : — this fact was well 
known to the ancients ; and they acted upon it, accordingly, by 
giving great attention to the little wants of the pregnant wo- 

1 " If the imagination or fancy of the parent possessed the influence alleged, it 
might he destructive of one of the most important ties in society ; for the sex 
might submit to an intercourse with blacks, and could easily conceal from their 
unsuspecting relatives the adulterous commerce, by the easy expedient of con- 
tinually fixing their attention on their husbands or on objects of a bright colour. 
If the imagination have the power of producing colours, why should not children 
be marked with grapes and green gooseberries, as well as with cherries, or red 
currants ? since it may be presumed that the mother will have as often longed 
for the one as the other; or why should we meet with deformities among the lower 
animals, and in plants, even, where the fancy, more especially in the latter, can- 
not be concerned." — Campbell's Introduction to Midwifery, &c, p. 115. 



OF FOOD. 39 

mean; removing from her all disagreeable and disgusting objects, 
and constantly presenting her with subjects calculated to excite 
admiration, or to create agreeable impressions on the mind. 

78. The ancient Greeks were firmly persuaded that the ima- 
gination of the female had an influence upon the beauty of the 
child ; hence the practice, as we have already noticed, (35) of 
constantly providing for the chambers of their wives the most 
beautiful specimens of art, such as the figures of Apollo, Bac- 
chus, Castor and Pollux, Antinous, Narcissus, &c. ; that they 
might dwell upon their fine proportions with that complacency 
of spirit which a beautiful object is sure to produce. And we 
believe, if this scheme ever had success, it was by producing a 
tranquillity of mind, rather than by any formative influence of 
the imagination. On this principle, also, we would explain the 
observation of Nicolai, 1 who, while visiting some of the Catholic 
provinces of Germany, found a number of female faces, divinely 
beautiful; especially when engaged in devotional exercises: this 
beauty had most probably been transmitted to them by mothers 
who enjoyed the calm and placid sensations which religious ex- 
ercises are wont to produce. Here, then, is a powerful motive 
to preserve equanimity, especially in the earlier months of preg- 
nancy ; as well as to curb a rising and rebellious spirit ; and, at 
the same time, by an indulgence in innocent pleasure, to chase 
away the gloom too common to pregnancy. 



CHAPTER V. 



OF THE FOOD PROPER FOR PREGNANT WOMEN. 

79. It is not necessary to give in detail the articles of food 
which may be proper for the pregnant woman ; especially, as in 
general they injure more by the quantity than the quality: a 
circumstance we have already adverted to, and which need not 
be repeated. But we must not pass over in silence the highly 
injurious effects of an indulgence in stimulating drinks. 

80. It is a truth that we must not disguise, that a habit of 
taking too large a quantity of strong drink is sometimes con- 
tracted during pregnancy, from a desire to overcome the un- 
pleasant sensation, commonly present at this period, by using 
some cordial or tincture, of high character for this purpose. 
Every body is aware how often nausea and other distressing 

1 Struve. 



40 OF FOOD. 

sensations assail the poor female, particularly in the early part 
of her pregnancy. To remove this, the good old gossip she 
may chance to consult recommends the use of the compound 
spirit of lavender, the essence of peppermint, noyeau, &c, which, 
by affording, perhaps, a temporary relief, is again and again re- 
sorted to — the quantity is, of course, a little increased at each 
time, that its effects may be maintained; and, by and by, the 
disgusting habit of tippling is too certainly established. 

81. No gratification is so dangerous as this: it should be de- 
sisted from the moment it begins to be importunate ; and a deaf 
ear should be turned to the dangerous maxim, "that if you want 
it, it will not hurt you." We have more than once seen health, 
domestic happiness, and even reputation, destroyed by this dan- 
gerous and insidious counsel. 

82. It must not, however, be imagined, that the extreme cases 
just stated are essential to constitute its hurtful tendency upon 
the foetus in utero. Intoxication is, comparatively, a rare vice 
among females ; yet some are too much in the habit of indulging, 
during the period of pregnancy, in the use of ardent spirits ; and 
it is wrongly imagined, that any quantity this side of inebriety 
is not hurtful ; than which nothing can be farther from the truth. 
For every thing that unduly stimulates the system at the time 
is highly injurious, by putting both the nervous and vascular 
systems in an unnatural condition ; consequently, the functions, 
so important to the welfare of the foetus, are interfered with, or 
imperfectly performed — and hence, the children of women who 
over-stimulate or become intoxicated, are always less healthy 
and less vigorous than those of mothers who observe a contrary 
conduct. 

83. We are persuaded, from what we have seen, that the 
indulgence referred to is most frequently the result of false im- 
pressions, impressions we should be happy to remove by de- 
claring to the deluded female that she cannot, from any circum- 
stance connected with her situation, gratify a disposition to take 
strong liquors without incurring the risk of destroying her own 
health and that of her child. 1 

84. From what has been said, it would appear, that the wo- 
man has an important duty to perform during the whole period 

1 We have been made acquainted with a lady who was determined to bring up 
her child in a novel way; she insisted that nature gave an appetite for nothing 
which it was really injurious to the individual to possess, and, with a view to 
discover (for the infant cannot indicate its wants,) she resolved to try the child 
with every substance that she ate and drank herself. She carried this so far, that 
she even forced a large oyster and a quantity of wine on the child at one time, 
when it was no more than twenty-four hours old; and she continued this practice 
until it was seized with convulsions and had nearly died. She then gave up her plan 
at the earnest solicitations of her husband, and the repeated advice of the phy- 
sician, but she was not convinced of the fallacy of her hypothesis, even by this 
demonstration. 



OF FOOD. 41 

of utero-gestation ; and, that her offspring may not suffer in 
either body or mind by her imprudence, she must most carefully 
avoid all the causes and circumstances enumerated above. Should 
she entirely neglect, or but imperfectly observe the rules so im- 
portant to the welfare of her child, she becomes culpable in pro- 
portion to the neglect. She may entail a frail constitution of 
body, a perpetual feebleness of mind, or even fatuity itself; or 
by exciting premature labour she may immolate herself and her 
offspring. 

85. To a feeling heart, the thought of having destroyed a 
child by heedlessness must be productive of the keenest anguish; 
and this feeling may be permanent in its effects. We well re- 
member an elegant, but rather careless young lady, who be- 
came a prey for several years to a settled melancholy, because 
she had but too much reason to attribute a premature labour to 
her own neglect. Even after she became the mother of several 
children, she reproached herself for the loss of the first; and 
time alone blunted the severity of her self-upbraidings. 

86. Were every female, during pregnancy, to regulate her 
conduct, as though she were accountable for the health and in- 
telligence of her child, it would prevent much of the mischief so 
constantly witnessed; for, like fruit, properly so called, the child 
in utero requires a certain amount of care for its preservation 
and perfection. 

87. There is another point remaining to be spoken of — one that 
is no less common than injurious ; namely, the attention which 
pregnant women accord to the chilling and horrifying tales of 
gossiping beldams. This is of general occurrence, and is ex- 
tremely injurious: their stories often sink deep into the mind of 
the unfortunate hearer, and tinge the remaining portion of her 
pregnancy with the most gloomy and melancholy forebodings. 
We have too often witnessed the evil tendency of this state of 
mind, not to warn the pregnant woman against indulging in 
these idle reveries — we once knew abortion very speedily follow 
a tale of horror; and, frequently, we have known months of 
sleepless nights succeed these evil communications. 

88. The following case of abortion, (alluded to above,) is every 
way illustrative of the influence of ill-directed conversation. 

Mrs. , in the fifth month of her first pregnancy, complained 

to an aged relative of a pain in her right side ; the old woman 
inquired minutely into its seat and duration, shook her head 
most significantly, and then said she was very sorry to hear her 

complain of that pain, as Mrs. , (a lady who had died a few 

days before,) complained in just the same manner, and it was 
owing to the after-birth growing fast to the side, from which 
the doctor was obliged to tear it piece by piece, and she died im- 
mediately after. The lady aborted before the next day. 



42 CONDUCT TO BE OBSERVED 

89. Having cursorily considered in the preceding pages the 
importance of care on the part of the female during gestation, 
that the best possible chance may be given to the child which 
she is carrying, we shall merely add a few words upon her con- 
duct, and that of her attendants, nearly at, and during the pro- 
gress of labour. 



CHAPTER VI. 

AND DURING LABOUR. 

90. It would be a gross neglect of duty, should the woman 
disregard certain rules, which are of high importance to her wel- 
fare, and that of her infant, at the approach of labour. We shall, 
therefore, lay them down for her consideration, even though she 
may not choose to adopt them for her government. 

91. 1st, Let her seek the best possible aid for this anxious 
moment that the nature of circumstances will permit, both as re- 
gards her physician and her nurse. The propriety of this ad- 
vice will at once suggest itself, without putting us to the neces- 
sity of giving our reasons. • 

92. 2dly, Let her not be impelled by false theories or by bad 
counsel, to use too much exercise towards the last period of preg- 
nancy. We are aware this is not popular advice, but it is cor- 
rect. For, she may be assured, whatever shall produce fatigue 
will do mischief by prematurely provoking labour. No animal, 
(save man,) when left to itself, at this period, disregards the 
natural instinct: it warns them against unnecessary motion or 
exertion, and they, therefore, always indulge in quiet and repose. 

93. 3dly, When symptoms warn her of the approach of this 
important moment, let her not indulge in gloomy forebodings, 
nor yield to unreasonable fears for the event. But, on the con- 
trary, let her console herself with the reflection, that death, or 
even an untoward accident, is of extremely rare occurrence, 
when the case is under the direction of a judicious practitioner. 

94. 4thly. When labour has actually commenced, let her not 
yield to an overwhelming anxiety to hasten its progress, by taking 
improper articles of diet or drink; nor, by repeated marchings 
in her chamber, hope to promote her general good, by exciting 
more numerous, or, apparently, more powerful contractions of 
the womb. Experience has never yet confirmed the propriety 
of this plan ; and, to us, it appears every way certain that it 
never can. This is not the place to give reasons for this belief, 



AND DURING LABOUR. 43 

but let it be relied upon, that it is entirely confirmed by obser- 
ration. 

95. 5thly, As the very efforts of labour, however successfully 
or quickly exerted, must necessarily tend to hurry and disturb the 
circulation, and thus dispose to fever, let every thing that can 
possibly increase the impetus of the blood, be carefully shunned, 
lest it take place — therefore, the woman must abstain most scru- 
pulously from stimulating victuals or drink during the progress 
of labour, under the specious, but false pretext, of supporting 
her strength, that she may the more successfully go through her 
appointed travail. Let her take the experience of others, on 
this point, for granted ; and this declares that an overcharged 
stomach is always unfavourable at this time. 

96. 6thly, Let not too much anxiety be indulged for the event ; 
nor too much apprehension be entertained, because the period 
of trial is of longer continuance than was anticipated. The pa- 
tient must recollect that the duration of labour is not absolutely 
under the control of any one ; and that, all things being equal, a 
slow delivery, especially with the first child, is safer than a very 
rapid one; and that eventual safety does not, in any degree, de- 
pend upon the speed with which this process is performed. 

97. Tthly, As it is taken for granted that the woman will 
employ no one in whom she has not proper confidence, to attend 
her at this important moment, let her not indulge in any opinions 
that may clash with those of her attendant; let her yield her- 
self entirely to his directions, for she cannot fail to know less 
than her physician ; therefore she is not entitled to be her own 
directress. 

98. 8thly, Let her especially guard against any gust of pas- 
sion, any childish waywardness, or unprovoked fretfulness, lest 
the nervous system be thrown out of balance, and hysterical con- 
vulsions ensue. 

99. 9thly, After she is blessed by the cries of her infant, a 
series of new duties immediately commences ; and she must now 
yield implicit obedience to the directions of her medical atten- 
dant; she must have no opinions of her own, as regards her 
physical and medical treatment: submission is her duty, that 
she may be able to discharge, in the best possible manner, the 
important task of watching over and rearing her offspring. To 
secure this power, the observance of the following rules, during 
her month of confinement, will be found important. 



44 CONDUCT DURING THE MONTH. 

CHAPTER VII. 

CONDUCT DURING THE MONTH. 

100. As the future health and welfare of the child after birth 
mainly depend upon the healthfulness of the mother, and her 
capacity to supply it with sufficient and proper nourishment, 
it will follow that this important office demands the utmost 
care, that she may be enabled to perform this delightful duty 
with comfort to herself and advantage to her child — therefore, 
she must, 

101. 1st, Avoid causes that may tend to produce or to aug- 
ment fever; as too early sitting up; unnecessary exposure; in- 
dulgence in too stimulating a diet, and drinks ; too hot a room ; 
too nearly closed curtains ; the exclusion of fresh air ; and seeing 
too much company. 

102. 2dly, She must aid, by her own good sense, the endea- 
vours of her physician to prevent the accession of fever; by not 
permitting the nurse, as is too frequently done, to run counter to 
his directions : she must, therefore, carefully examine her articles 
of diet, that no improper or forbidden substance enter into its 
composition, as wine or liquor of any kind, animal food, or broths, 
until after the complete secretion of milk has taken place, and 
all risk of "milk fever," as it is called, be at an end; that is, 
not until after the termination of the fifth day. 

103. 3dly, With a view to give the best possible chance for 
the breasts to perform their functions properly, and to prevent, 
as much as may be, the occurrence of that bane to nursing, sore 
nipples, she should have the child applied to them as soon as 
she is sufficiently recovered from her fatigue to permit it ; and 
this must be repeated every four or five hours, should nothing 
occur to render it improper. 

104. 4thly, She must not delegate to any being the sacred 
and delightful task of suckling her child, unless there be the most 
decided and insurmountable impropriety in continuing it at her 
own breast. 

105. 5thly, She should most scrupulously attend to the dressing 
and undressing of her infant, if she cannot perform these offices 
herself; and also pay the strictest attention to its cleanliness; 
not suffering it to remain either wet or soiled, under the false 
pretext of making it hardy. 

106. 6thly, The mother should not permit her child to be 
fed, while she herself can supply it with sufficient nourishment : 
to insure this of proper quality, and in proper quantity, she 



OBSERVATIONS. 45 

should eat nothing which her experience has proved to be in- 
jurious ; and she should take as much exercise in the open, dry 
air, (as soon as her health is sufficiently confirmed to permit it,) 
as will contribute to the restoration of healthy action in her 
•whole system. 

107. The rules we have just laid down for the woman's ob- 
servance during her labour and her getting up, as it is familiarly 
called, may require a few remarks to make them entirely intel- 
ligible, or to ensure conformity. 



CHAPTER VIII. 



OBSERVATIONS ENFORCING THE FOREGOING RULES. 

108. To the first (91) we may observe that in the present im- 
proved state of midwifery the risk of labour, when properly con- 
ducted, is very much diminished. This improvement has arisen 
from that change of manners which placed the care of the fe- 
male, almost universally, in the hands of the male practitioner; 
and to the latter cultivating this branch upon correct and well- 
founded principles ; principles derived from the laws of nature, 
and from correct observation. 

109. The officiousness of ignorant practitioners, (as well male 
as female,) of this branch of medical science, arising either from 
a desire to be useful, or their supposing they can be so during 
the progress of a natural labour, becomes a fruitful source of 
immediate as well as remote evil. How many females may truly 
date the origin of many long-continued diseases from the im- 
proper interference and misconduct of the midwife or physician, 
in their first confinement. 

110. It is proper we should say a few words in defence of our 
second direction, (92) as general opinion is against it; but we 
can safely say we have both reason and experience in its favour. 
Towards the latter period of gestation there is, we believe, in 
almost all women, an inclination to repose; or it is rather, per- 
haps, an aversion from exercise ; this arises, in most instances, 
from the inconveniences which are experienced from locomotion, 
owing to the increased weight of the womb and its contents ; and 
the constant exertion necessary to preserve the centre of gra- 
vity. Hence, we find women who may have borne several chil- 
dren experience oftentimes much difficulty in preserving their 
centre of gravity, owing to the position the uterus takes, espe- 
cially after the seventh month, at which period the womb hangs 



46 OBSERVATIONS. 

somewhat pendulous over the os pubis. Hence the disposition 
to a recumbent posture, as they find themselves more comfort- 
able in it ; and hence the impropriety of interfering with this 
instinct. Besides, a long experience is in favour of our caution ; 
we have a hundred times seen pains of labour prematurely ex- 
cited by over-exercise near the end of gestation; we, therefore, 
uniformly protest, when consulted on this subject, against long 
walks, &c, byway, as is declared, of procuring a favourable de- 
livery. 

111. We are not, however, to be considered as unfriendly to 
all exercise at this time; on the contrary, we frequently recom- 
mend a moderate share of it — but we earnestly caution against 
fatigue; and, consequently, forbid exercise to any extent that 
will produce it. And, if the analogy to which we have already 
appealed can furnish an argument in favour of our position, we 
may certainly be taught a useful lesson, upon this subject, from 
the practice of the brute creation. 

112. The consolation afforded in our third rule, (93) is founded 
upon extensive calculations, made from the reports of cases from 
different parts of Europe, and of this country; as well as upon 
those of many public institutions, in which the best possible 
chance offered itself for accuracy; and all of these tend to show 
how few women now die in child-bed, except occasionally, when 
some epidemic influence prevails to give childbed fever. But 
let it be remembered, that this exception is almost exclusively 
confined to Europe, as we seldom or never witness such an at- 
mospheric agency in this country. 

113. The cautions suggested in our fourth, (94) are the result 
of long and repeated experience; for no truth connected with 
the practice of midwifery is better established than the one that 
declares, as a general rule, that the preparative stages of labour, 
properly so called, should never be interfered with, by any at- 
tempt to hasten or retard their natural march. When this has 
been attempted, the effects have ever been mischievous ; there- 
fore, the whole discipline to which a young creature is subjected 
by misguided gossips, or ignorant practitioners, especially with 
her first child, cannot be too severely reprehended. But we 
must not be understood to include in our censure the proper 
and well-timed administration of suitable remedies, to relieve 
premature or inefficient pain, which frequently attacks the 
female ; especially if her domestic duties require much or con- 
stant exertion. 

114. But, at the same time, let it be remembered, that, in 
administering to real exigencies, much caution and judgment are 
required; and the cases where such necessity exists should be 
confided to the care of an experienced practitioner. The indis- 
criminate use of laudanum, the lancet, and stimulating teas and 
drinks, cannot be too severely condemned, or too much feared. 



OBSERVATIONS. 47 

115. Our fifth rule (95) is one of great importance, yet popular 
feeling is decidedly in favour of its violation. It is wrongly ima- 
gined, that great muscular strength is essential to the due per- 
formance of labour, and that this can only be supported by the 
free use of nourishing and stimulating articles of diet; hence 
the common practice of urging patients to eat and drink " to 
keep up their strength ;" and hence, the too frequent production 
of fever. But let us place the result of experience in opposition 
to it ; — this declares that relaxation is the most favourable con- 
dition of the system for safe and speedy delivery. 

116. The sixth admonition (96) is intended to prevent despon- 
dency in consequence of protracted labour, especially with a first 
child. It should be constantly borne in mind, that the progress 
of labour, as a general rule, is almost always slower with a first, 
than with subsequent children : the cause of this peculiarity w§, 
are not exactly prepared to state ; the fact is notorious, however, 
and should be declared to be so to the impatient sufferer ; espe- 
cially when it can also be confidently declared that there is no 
more danger, all things being equal, and under proper manage- 
ment, than with any subsequent ordinary labours. This may 
tend to inspire a proper confidence in the powers of nature, and 
in the skill of the attendant; points of much consequence at 
this period of suffering. Thus, needless anxiety and injurious 
impatience may be prevented. Rules 7th, 8th, and 9th, suffi- 
ciently explain themselves. 

117. The first rules (101 and 102) are intended to prevent that 
artificial condition of the system termed "milk fever:" we say, 
"artificial condition of the system;" for such, in our estimation, 
it almost always is. It is found constantly to exist where the 
patient has indulged in the early use of either distilled or fer- 
mented liquors, animal food, broths, too great quantities of spices, 
or where any of the other causes enumerated in the proscription 
are in operation. We could wish that the directions contained 
in the rule, (101) may not be carelessly passed over; as "milk 
fever very often leads to the necessity of pretty active medical 
discipline, which must necessarily retard recovery, by producing 
weakness, or, what is oftentimes very much worse, the formation 
of "milk abscess," — a disease of long and painful continuance, 
and sometimes the cause of the entire destruction of the future 
usefulness of the breast itself. The child must now be robbed 
of its natural support, languish for want of proper nourishment, 
or be committed to the care of perhaps a careless or profligate 
nurse, who may entail upon it never-ending disease or debility. 

118. The second rule, (102) is an appeal to the good sense of 
the patient, that the directions of her physician may not be 
disregarded, or she become the sufferer by her own supineness. 
A lying-in woman is looked upon, by the ignorant nurse, as in 



48 OBSERVATIONS. 

a state of great debility; with a view to overcome this creature 
of her imagination, she employs all her powers of cookery, for 
a system already assailed, perhaps, by fever, or very certainly 
disposed to it; — fever is kindled, and, sometimes, before it can be 
quenched, the patient entirely succumbs, or escapes with a painful 
and protracted convalescence. Does it not then become the 
duty as well as the interest of the patient, to co-operate with 
her physician in the proper application of his remedies, and in 
the observance of his directions ? It should be constantly borne 
in mind, that no patient runs counter to the directions of her 
physician, but at the risk of her health, perhaps of her life ; — 
therefore, the common boast of ignorant and unprincipled nurses, 
that they have u cheated the doctor," betrays at once their dis- 
honesty and total unfitness for the duties they are hired to per- 
form. If every woman would decidedly and firmly oppose the 
impudent and dangerous practices of her nurse, when they run 
counter to medical counsel, we have every reason to believe it 
would not only abridge suffering, but also diminish the risk of 
parturition. 

119. Let it not be hastily assumed that there is more safety 
in following the directions of a nurse, than those of the physician, 
because she may have had some experience: for it must be 
quickly perceived, that the calculation is much in favour of the 
latter; for the nurse can attend but twelve patients per annum, 
while the physician may attend several hundreds in the same 
period; besides, his knowledge of the laws of the human system 
gives him a very decided superiority. 

120. Our third direction (103) contains most important advice, 
and should be scrupulously complied with, if the woman wish to 
avoid inquisitorial tortures, or be enabled to render justice to 
her child. A neglect of the caution suggested in the article we 
are now commenting on, will almost certainly be followed by 
sore or tender nipples. When this happens, a series of evils 
constantly ensues. 1st. The mother suffers extreme pain, when- 
ever she attempts the duty of suckling; this necessarily produces 
a great reluctance to apply the child to the breast: the period 
of its application is postponed from hour to hour, until the painful 
distention of her breasts forces her to compliance. But in con- 
sequence of the accumulation of milk in the milk-vessels, they 
become over-distended, painful, or even inflamed; so that, when 
the child is applied to the nipple, its attempt to empty the breast 
is attended with such severe pain, that the infant is almost in- 
stantly torn from it, leaving the part denuded of its skin, and, 
perhaps, covered with blood. 

121. Secondly, In consequence of the extreme reluctance the 
mother feels to nursing her child under such circumstances, the 
breasts are imperfectly emptied, and the milk becomes, as it were, 



OF THE TREATMENT OF THE NIPPLES. 49 

stagnant; or, at least, it undergoes such changes as render it 
improper food for the child, and it also becomes impacted in the 
lactiferous vessels. Accumulations are formed, inflammation is 
excited, and the milk abscess follows. 

12:2. Thirdly, From the condition in which the breasts are 
placed by the unexhausted milk, the child is not only made to 
receive it of bad quality, but also in an insufficient quantity: it, 
therefore, throws it up almost as soon as swallowed; it is attacked 
with disordered bowels and colic, and soon becomes most misera- 
bly emaciated, when perhaps nothing but a fresh breast of milk 
can save it from an untimely grave. The evils we have here 
enumerated are of frequent occurrence; and so certain are they 
to follow this condition of the nipples, that we declare we have 
rarely seen a well nourished child under such circumstances. 

123. It follows, then, that as a sound condition of the nipples 
is of the first consequence to the mother and the child, and as it 
materially influences the future health of the latter, the conside- 
ration of the best mode of preserving them properly belongs to 
our immediate subject. 



CHAPTER IX. 

OF THE TREATMENT OF THE NIPPLES. 

124. In treating this subject, we shall first briefly inquire into 
the causes of sore nipples; and, secondly, point out the best 
mode with which we are acquainted for their prevention and 
cure. 

125. The removal of the skin which covers the nipple, by the 
application of the child's mouth in the act of sucking, is almost 
always owing to the milk-vessels being over-distended, and to an 
incipient inflammation besieging them in their course, and espe- 
cially their extremities, which open on the extreme end of the 
organ; or sometimes to some of these little openings being; 
nearly or entirely obliterated by compression, or previous inju- 
ry; thus requiring considerable, and repeated force, to extract 
the milk from them. The friction which the nipples suffer, from 
the attempt to draw off the milk, soon renders these, parts ten- 
der; and, in a short time more, the skin is entirely removed. 
From that moment, the woman bids adieu to all comfort in suck- 
ling ; for the child's frequent demands for nourishment prevent 
their healing. 

126. Now, it would seem from the premises just laid down, if 
we can prevent the over-distention and inflammation of the 

4 



50 OF THE TREATMENT OF THE NIPPLES. 

milk-vessels, and remove the obstructions from their external 
extremities, we should destroy the necessity of that degree of 
force, which we have just declared to be the efficient cause 
of sore nipples; and, consequently, protect the woman against 
them. To do this, we must most rigorously enforce the rules 
we have laid down for the conduct of the woman immediately 
after delivery, and persevere in them until the necessity shall 
cease. 

127. Besides this, the patient should begin to prepare these 
parts previously to labour, by the application of a young, but 
sufficiently strong puppy to the breast; 1 this should be immedi- 
ately after the seventh month of pregnancy. By this plan the 
nipples become familiar to the drawing of the breasts ; the skin 
of them becomes hardened and confirmed; the milk is more 
easily and regularly formed; and a destructive accumulation 
and inflammation is prevented. 

128. A variety of washes have been recommended for the 
purpose of hardening the nipples; but, so far as we can learn, 
or have observed, they have rarely succeeded; nor can such 
washes succeed often from their very mode of action— for it is 
not so much an unusual tenderness of skin that gives rise to this 
complaint as the degree of force which becomes necessary to 
extract the milk when these parts are over-distended or inflamed. 
The true theory, then, of prevention is, so to manage the breasts, 
that neither over-distention nor inflammation shall take place. 
We have above suggested the proper mode of doing this ; name- 
ly, before delivery, by the regular application of the puppy; 
and, after delivery, by the early application of the child to the 
breast, and a strict antiphlogistic regimen. 

129. Professor Osiander lays great stress upon the daily use 
of lukewarm water and fine soap; the nipples, he says, should 
be washed with them every day for some time before delivery ; 
by which means the hardened scarf skin, after a short time, can 
readily be removed by the finger, a blunt knife, or the edge of 
a card. When this is removed, he recommends hardening the 
tender nipple by certain stimulating applications; but of which 
we do not approve — the best plan, we believe, after washing is 
to expose the nipples to the air for a few minutes at a time, and 
several times every day. 

Dr. Strahl, in Rust's Magazine, recommends the following lo- 
tion in very positive terms, by calling it a "specific." 

1 We would not wish to be understood as considering the mouth of a pup better 
than that of a nurse, or one who is accustomed to this operation ; on the contrary, 
when practicable, we would prefer the latter, as she can always regulate the force 
necessary for this purpose. We merely recommend the pup, because it is more 
easily procured. 



OF THE MOTHER SUCKLING HER CHILD. 51 

R — Pulv. Gallse Alep sjVj. 

Vin. Alb |vj. 

digest with gentle heat for twenty-four hours ; strain, and apply 
compresses wet with it three or four times a day, beginning as early 
as the sixth month of gestation, and continue until the full time. 

130. It, perhaps, may be useful to suggest that these impor- 
tant parts are very frequently injured by compressing them too 
tightly against the breast with corsets, &c. This should be 
guarded against with much care, by every female, whether she 
be married or single; and for this purpose they should be pro- 
tected, especially in the pregnant woman, by an opening in the 
jacket, corsets or stays, so as to leave them at perfect liberty. 

131. Some women are so unfortunately organized, as to want 
the nipple altogether, or to have it very short, or sunken in — 
such may have the inconveniences necessarily attached to this 
malformation remedied or improved, by the early use of the pup- 
py, or the daily drawing them out with a large tobacco pipe. 1 

132. Our fourth rule (104) contains one of the most impor- 
tant injunctions we can give, or that the woman can receive : it 
forbids her to delegate to another the duty of suckling her child 
— a duty rendered sacred both by nature and reason — an em- 
ployment that awoke the poetic powers of a Tansillo, and aroused 
the eloquence of a Rousseau. 



CHAPTER X. 

OF THE MOTHER SUCKLING HER CHILD. 

133. We shall consider this subject under several of its rela- 
tions: — 1st, that of duty; 2dly, of pleasure; 3dly, as it may 
affect the mother's health ; 4thly, as regards the health of the 
child; 5thly, the consequence to both, when neglected; 6thly, 
the alternatives of this neglect, and their effects. 

'Mrs. was confined with a fine healthy boy: the secretion of milk was 

most plenty and favourable; but the child could not be made to take hold of the 
breast, as the nipples were inverted. The breasts became painful from extreme 
distention; as even the nurse, who was well skilled in drawing breasts, could not 
without much difficulty extract sufficient to take off distention. Much mischief 
was now threatened. Milk abscesses were to be feared ; the child was obliged 
to have a wet nurse, and the pain the mother suffered from the breasts was only 
relieved by bleeding, purging, extremely spare diet, and the application of hot 
vinegar: every thing, however, terminated favourably, by a rigid adherence to 
this plan. Upon the next occasion, a pup was procured, and the breasts were 
drawn several times every day ; the nipples were now made to appear, as the 
breasts were not distended: this plan was pursued until after her delivery, and, 
by the time milk was formed, the child had very good nipples to take hold of. 



52 OF THE MOTHER SUCKLING HER CHILD. 

Sect. I. — As a Duty. 

134. God has declared, almost in every part of his living crea- 
tion, that the female, for a certain time, is the natural protector 
of her offspring ; to the human female he has been particularly 
emphatic, implanting in her affections which are rarely subdued ; 
and by giving her an organization most wonderfully fitted for 
the exercise of her best and most enviable feelings. He has 
given her double means to furnish nourishment for her helpless 
young, lest accident should circumvent his kindest purpose; and 
he has so arranged their powers as to yield the wanted supply, 
as soon as that supply may be necessary. 1 

135. Every woman feels, but all unfortunately do not obey, 
these powerful appeals — to the latter, and to the latter only, is 
it thought necessary to address arguments for the discharge of 
one of the most sacred of duties; and to make her, if possible, 
alive to her own interests and her own happiness. 

136. We are truly happy to find, and equally so in this op- 
portunity to declare, that the number of women who may stifle 
this strong maternal yearning, is comparatively small, and form 
only exceptions to the noble rule — and that it may ever continue 
to be so, we most devoutly pray. That such exceptions have 
always existed, our earliest records would seem to declare ; and ? 
that the example has ever had but very limited influence, we 
are proud to admit — for to the honour of human nature, such 
mothers have ever been the subject of the satirist's lash, and 
the object of the moralist's declamation. 

137. By some, this neglect has been looked upon as absolute- 
ly criminal; and by Tansillo, no distinction is made between the 
woman who voluntarily procures abortion, and the one who aban- 
dons her child to the care of others, and leaves it to perish; for 
he asks — 

"Does horror shake us when the pregnant dame, 
To spare her beauties, or to hide her shame, 
Destroys, with impious rage, and arts accurst, 
Her glowing offspring, ere to life it burst — 
And can we bear, on every slight pretence, 
The kindred guilt that marks this dread offence? 

*7F "?F *tP "Tt w w 

She, who to her babe her breast denies, 

The sentient mind, the living man, destroys. * ; 

The Nurse, translated by Roscoe, p. 11. 

138. In such light is the mother's voluntary abandonment of 
her child viewed by stern morality — we, however, do not regu- 
late our opinion by so rigid a standard ; for we hold it right in 
this, as in every instance of imputed turpitude, to fix the grade of 

1 Dr. Darwin has some curious speculations upon this subject. 



OF THE MOTHER SUCKLING HER CHILD. 53 

enormity by the quo animo ; and, if this be made the test, as it 
certainly should be, it will be found much less flagrant than it 
would appear at first sight: for, we know that but few mothers 
can be found, who would voluntarily consign their offspring to 
inevitable death ; and we believe, when this cruel and unnatu- 
ral repudiation takes place, it is generally owing to a temporary, 
but morbid suspension of the social and moral perceptions, rather 
than to a destruction of them; and, were proper means judi- 
ciously applied, they might be recalled, and the woman restored 
to a healthy and natural state of feeling. 

139. It should be made known to her who may feel a tempta- 
tion to put away her child, from mere selfish gratification, that it 
has also been a subject of question, " whether the child which 
has been voluntarily abandoned by the mother to the care of 
others, should owe a tie, of either consanguinity, or of gratitude, 
to her." This doubt must be resolved by the mother herself — 
we shall not undertake to decide it, lest our feelings should be- 
tray a stronger bias than ought justly attach to the subject, 
from the hasty consideration we have given it. 

140. It would not, however, be right to throw all the blame 
upon the mother who does not suckle her child ; the husband is 
sometimes so fashionably selfish; so unnaturally studious of his 
own ease, or comfort; and so ridiculously vain of his wife's ap- 
pearance; as to force a tender and affectionate mother from her 
duty; and this, sometimes, even to the sacrifice of her health, 
as well as that of his child. In this country, this character is 
much more rare than in Europe ; and we sincerely hope they 
may never increase, either by the contaminating influence of ex- 
ample, or by the destruction of social virtue. 

141. In a political point of view, this subject may well merit 
consideration; for the pride of birth and of blood may justly 
take the alarm, if the theory of Tansillo have a foundation : for 
he asks — 

"Why, 'midst the fellow tenants of the earth, 
This high respect to ancestry and birth? 
Avails it aught from whom the embryo sprung, 
What noble blood sustained the imprisoned young, 
If, when the day-beam first salutes his eyes, 
His earliest wants a stranger breast supplies ? 
From different veins, a different nurture brings, 
Pollutes with streams impure the vital springs, 
Till every principle of nobler birth, 
Unblemished honour and ingenuous worth, 
Absorbed and lost, he falsifies his kind, 
A grovelling being with a grovelling mind." 

The Nurse, p. 27. 

Sect. II. — As a Pleasure. 

142. If we can believe the fond mother upon this point, there 
is no earthly pleasure equal to that of suckling her child — and 



54 OF THE MOTHER SUCKLING HER CHILD. 

if any reliance can be placed upon external signs, she is every 
way worthy of belief. This pleasure does not seem to be the 
mere exercise of social feeling while the mother is witnessing the 
delight of the little hungry urchin, as it seizes upon the breast 
— nor from the rapturous expression of its speaking eye, nor 
the writhing of its little body from excess of joy — -but from a 
positive pleasure derived from the act itself; for most truly it 
may be said, when 

i; The starting beverage meets its thirsty lip, 
7 Tis joy to yield it, as 'tis joy to sip/"' 

The Nurse , p. 15. 

143. Yet there are mothers who voluntarily forego this plea- 
sure, by committing their helpless offspring to mercenary nurses ; 
or who fail not to mar it, by degrading this delightful act to a task 
by reducing the periods for its performance to rule ; and even this 
rule regulated by selfishness, rather than by the demands of their 
beseeching infant — but in yielding thus to sinister feelings, may 
it not be justly considered a moot point, whether such a woman 
should be most pitied or despised ? for she may well be asked, 
if, by this neglect, 

u She can hope to prove 
More bliss from selfish joys than social love?'* 

In part, even a father, upon such occasions, knows how to feel 
a mother's joy, or an infant's bliss; nor would he yield them 
for any price. 

Sect. III. — As it may affect the Mother s Health. 

144. Nature here pleads her own cause, by creating, and even 
perpetuating, disease in the mother who may refuse this justice 
to her child — she becomes liable to milk abscess in its worst 
form; to translations to various parts of the body; to conges- 
tions in the milk glands, which may become scirrhi, or even 
cancers. We have known, in several instances, long-protracted 
headaches to follow this unnatural abandonment of the child, 
which nothing but time seemed capable of relieving. One case, 
in particular, may be worthy of relation, as it is every way in 

point: Mrs. , the mother of several children, was severely 

afflicted with headache, sore eyes, and a long train of nervous 
symptoms, which rendered her life miserable, and for which al- 
most every remedy had been tried in vain. 

145. We attended her for these complaints, at the desire of a 
friend ; but as she was pretty far advanced in her fifth preg- 
nancy, we could neither hope nor promise to do much for her 
relief at that time : we, however, commenced a very particular 
inquiry into the origin and progress of her disease. From this 



OF THE MOTHER SUCKLING HER CHILD. 55 

we learned that these unpleasant symptoms attacked her soon 
after her first confinement; and they seemed to gain ground, after 
each of these events, until they became almost unsupportable. 

146. Immediately after each confinement, and for a short 
period in the month, she would experience a slight relief; but 
by the time her month was up, it would return with renewed 
force, and would leave her but at rare intervals, even for an hour. 
We next inquired into her habit as regarded nursing her children ; 
and understood that she had never suckled one of them; having 
lost her first a few days after its birth, she dried up her milk, 
and was soon after attacked with the complaints just mentioned. 
But so far from either herself or her friends attaching any 
blame to the sudden repulsion of the milk, she was forbidden 
by her husband, her friends, and her physician, from ever at- 
tempting this office, as she had become so extremely debilitated, 
in their apprehension, as to render even the attempt dangerous 
— accordingly, a wet nurse was always procured beforehand ; and 
the mother's milk, as before, was prevented from taking its 
course. 

147. From this account, as well as from a variety of other de- 
tails not necessary to mention, we were at once instructed in the 
nature of her disease — for it was nothing more than a plethora 
arising from repelled milk ; for the cure of which we proposed 
she should nurse the child she was then pregnant with, and to 
follow such farther directions as the necessities of the moment 
might suggest — this was agreed upon. In due time, she was de- 
livered of a small, but apparently healthy child — the child was 
early put to the breast, in conformity with our practice : strict 
attention was paid to the mother, as regarded regimen, &c, during 
the month. Milk was plentifully secreted in proper time; the 
child throve ; and the lady never had a return of headache ; her 
eyes became strong and perfectly sound, and the w r hole train of 
nervous symptoms vanished, to return no more. These are not 
the only advantages of this plan — we are of opinion that the 
risk of childbed fever is much diminished by the mother suckling 
her child — for the consent or sympathy between the uterus and 
breasts is well known; and had not escaped the observation of 
the sagacious Hippocrates, two thousand years ago. 

148. This case is replete with instructions to the mother, who 
may voluntarily abandon her infant, by showing that a severe 
and protracted disease may follow what she might look upon as 
a safe expedient ; it is full of practical importance to the phy- 
sician, who may be tempted to disregard the consequences of 
"repelled milk." But though confessedly important, it is nei- 
ther new nor rare — for unnatural mothers, " over-tender and 
fashionable husbands," and inexperienced physicians, have ever 
existed. Tansillo, whom we have already so often quoted, was 



56 OF THE MOTHER SUCKLING HER CHILD. 

one of the "over-tender, and fashionable husbands;" and la- 
ments, in a strain of beautiful pathos, his error on this subject, 
in the following words : after having just before described the 
evils which this practice might give rise to, he says — 

" Nor think your poet feigns. Alas ! too well 
By dear experience I the truth can tell ; 
In dread suspense, a year's long circuit kept, 
And seven sad months I trembled and 1 wept, 
Whilst a loved consort pressed the couch of wo, 
And death oft aimed the oft averted blow, 
Nor hers the fault — misled by fashion's song, 
; Twas I deprived the mother of her young ; 
Mine was the blame ; and I, too, shared the smart, 
Drained was my purse, and anguish wrung my heart." 

149. It may be asked is every woman capable of nursing her 
child? To this we must answer, No: and when we declare it 
to be the duty of every mother to do so, it is to be understood 
only as referring to every mother who is capable of this impor- 
tant office. We are aware there are causes which will render this 
attempt neither obligatory, nor even proper; but such cases 
should be carefully distinguished; and should only be considered 
such when they have the sanction of an experienced physician 
— neither the want of inclination to fulfil one of the most im- 
portant duties of female life, nor the specious pretext of feeble 
or ill health should ever be admitted as sufficient reasons for such 
dereliction. 

150. To the intelligent practitioner these pretexts are of easy 
detection ; and to render it within the capacity of any one, he 
need but recollect the consequences of the judgment of Solo- 
mon upon (we had almost said,) a similar occasion. The pro- 
position to separate the child from the feeling mother is heard, 
as if it were her death knell; but by the selfish and unfeeling 
one, is received with decided approbation, if not with joy. Of 
the causes which would render it improper for the woman to 
suckle her child, we shall have occasion to speak under the head 
of "food." 

Sect. IV. — As it may affect the Child. 

151. As we hold it to be an indispensable duty on the part of 
the mother to suckle her child, so nothing but the most satisfac- 
tory evidence of incapacity, or of bad milk, should be ad- 
mitted as a reason for its neglect — but as such satisfactory evi- 
dence must necessarily sometimes exist, it follows that the child 
must become an alien to its mother's bosom. In such a case, it 
is the exception and not the rule that is acted upon. 

152. The arrangement made for the nourishment of the child 
by the secretion of milk, declares, as we have already said, a 



OF PHYSICAL INJURIES. 57 

mother's duties towards it; it also forces upon us the truth, that 
none other can be so entirely proper as that which she is des- 
tined to furnish. If this be true, as it unquestionably is, it fol- 
lows, as a consequence, that the child must incur a greater or 
less risk whenever it is deprived of it, either by choice or by 
necessity; it is, therefore, proper, that we consider the nature of 
that risk. 

153. The injuries which a child may receive, when condemned 
to the care of a hireling, may be of two kinds; namely, I. Phy- 
sical, and II. Moral. 



CHAPTER XL 



I. OF THE PHYSICAL INJURIES. 



These may be inflicted upon the child by a deficiency of milk ; 
by its bad quality ; by a just and proper care not being paid to 
its many necessities ; by the selfishness of the nurse ; and by the 
propagation of an actual or an occult disease. 

Sect. I. — By a Deficiency of Milk. 

154. As there cannot be any absolute security against imposi- 
tion from that class of females who hire themselves for wet 
nurses, there must be a constant liability to be deceived. For, 
as a matter of course, they will answer questions in such a man- 
ner as will give the best chance to be engaged ; they will there- 
fore declare they have the greatest abundance of milk, and will 
offer, perhaps, in proof of it, a fully distended breast — you re- 
ceive them under such appearances ; and your child for the first, 
and perhaps the last time, receives a sufficient supply. 

155. For, upon subsequent applications of the child to the 
breast, it is obliged to put up with meager fare — the woman, 
aware that the deception she has practised will be discovered with- 
out the exercise of both cunning and address, has immediate re- 
course to clandestine feeding; and that, perhaps, of the most 
varied and improper kind. Under such management, the child 
soon becomes pained and fretful, from a deficient and improper 
diet; but the fears of the mother are for awhile appeased by 
the nurse declaring it to be the " colic " attendant upon a change 
of milk. Things proceed pretty much after this fashion for 
some time longer; and though the child cries less, and sleeps a 
great deal, it does not thrive ! — but, on the contrary, there is a 
great falling off, and, perhaps, a severe diarrhoea is added — the 



58 OF PHYSICAL INJURIES. 

mother now takes the alarm, and her physician is consulted. 
From the history given, he suspects the true cause of the child's 
diminished health — an inquiry is instituted, and it eventuates in 
the discovery that the nurse has not sufficient milk, and that 
the child has been quieted and apparently satisfied, by the regu- 
lar exhibition of laudanum! ! This is not "fancy's sketch" — 
it is drawn from the life. 

Sect. II. — From Milk of a Bad Quality. 

156. The healthy quality of milk may be destroyed or im- 
paired sometimes without its quantity being very sensibly di- 
minished; and though the child may receive abundance, it may 
not be sufficiently nourished. When this happens, we find the 
child rejecting the milk soon after it is received; or it passes 
with rapidity and pain through the bowels. If the diapers be 
examined, the evacuations will be found copious and watery: 
offensive in smell; of a light green colour, and mixed with a 
portion of undigested milk curd. These discharges may not be 
very frequent, yet so large as rapidly to weaken the child; a 
proof that but a small proportion of the milk received had been 
converted into nourishment. 

157. The child becomes uneasy, fretful, and very frequently 
disturbed in its sleep ; it suddenly cries, as if in violent pain, 
and again falls into unrefreshing slumbers. It becomes pale; 
its flesh is flabby; and after a short continuance in this state, 
emaciates suddenly and becomes alarmingly ill from diseased 
bowels, or disordered head. 

158. There are many causes which may give rise to this bad 
state of the stomach; the too free use of ardent or acescent 
drinks; bad organization of the breasts themselves; too great 
age of the milk ; the irregular returns of the catamenia, &c. &c. 



Sect. III. — A want of due Care to the various Necessities of the 

Child. 

159. It truly requires all the affection of even a, fond mother, 
to administer duly to the numerous wants of a young child — we 
mean here only such wants as are really essential to its health 
and comfort, and not those of an artificial kind, which a fasti- 
dious and capricious taste may quickly create. The cares es- 
sential to the comfort of the child consist in the proper and 
regular application of it to the breast, that it need not suffer from 
hunger, or be injured by too long abstinence; in a proper and 
due attention to cleanliness ; and in the establishment of regular 
and useful habits, as regards exercise, exposure, sleep and evacua- 
tions. 



OF PHYSICAL INJURIES. 59 

160. It will readily be admitted that the proper discharge of 
these essential points requires more affection for the child, and a 
higher sense of duty, than can generally be found united in a wet 
nurse; and it also follows, if they are all, or even in part neglected, 
that the child must suffer. 

Sect. IY. — From the Selfishness of the Nurse. 

161. Mothers who are fondly attached to their children, are 
fully aware of the many privations they are obliged to submit 
to, while they continue to be nurses; and they but too often feel 
that it requires "all a mother's love " to perform the various 
duties of one without complaining, or feeling "the task severe." 
It must not then be a matter of surprise, that the hireling be- 
comes restiff and negligent, under the discharge of her multiplied 
cares ; and the child suffers in consequence. 

162. This selfishness, however, may exist in different degrees ; 
and the child will suffer, of course, in proportion to the neglect 
it may experience. One of the most common causes of neglect 
is, where the duty to the child interferes with the engagements 
of the nurse, and thus interrupts the consummation of anticipated 
pleasures. Should this happen several times in pretty quick 
succession, she becomes soured, and will contrive that it shall 
not happen soon again. 

163. Nurses generally make a point to have a certain period 
of the day at their command; and should they find this hour re- 
peatedly interfered with by the wakefulness of the child, they will 
soon have recourse to such means as shall prevent its future re- 
currence. We have known a number of cases where laudanum was 
administered for this purpose, with so much cunning as to elude 
detection for a long time, even after the suspicion had been ex- 
cited. In one of these instances, the wily nurse boasted to the 
abused parent of her good management, in establishing so much 
regularity in the child's sleeping. 

164. When a nurse is determined to employ laudanum for 
sinister purposes, she may do it for a long time before she may 
be detected, notwithstanding the vigilance of an anxious mother. 
There are moments when she must be alone with the child ; and 
there are stratagems by which her purpose is effected, of which 
the parent never dreamed. One of the most remarkable of this 

kind we have met with we will relate. Mrs. requested us 

to visit her infant of nine months old, which, without any ap- 
parent indisposition, had slept unusually long and unusually 
sound, for two or three days. When we arrived, the child was 
still asleep : we sat by the side of its cradle for some time, in order 
to observe any phenomena that might present themselves. The 
character of the sleep was marked by that peculiarity which a 



60 OP PHYSICAL INJURIES. 

practised eye and ear immediately ascribe to opium ; and we 
accordingly declared it to be our opinion that the child had taken 
a quantity of this drug. 

165. Both mother and nurse protested, in the most positive 
manner, that it had not taken a particle of that medicine in any 
form whatever — we were equally positive it had ; and directed 
our curative plan upon this belief. Upon our next visit, the 
child was much relieved — it nad vomited freely, and had kept a 
considerable quantity of rich lemonade upon its stomach, which 
seemed to control the influence of the (as we supposed) lauda- 
num. 

166. Before we left the house, we reiterated our suspicions to 
the mother — she, as before, was very certain it had taken no 
laudanum ; and urged, in support of this belief, that the nurse 
never had been left alone with the child for a single instant; for 
when she was about to leave it herself, she was sure to place a 
young woman in the room, in whom she had the most entire con- 
fidence; and this young woman had assured her, in the most 
solemn manner, that she never saw her give the child any thing 
whatever, with the exception of the breast. We, however, did 
not give up our first opinion, and proposed to the mother, w T hen 
the nurse w r as asleep, to make an examination of her pockets ; 
in one of which we were sure a bottle of laudanum would be found. 
At our visit the next morning, we were told by the mother, with 
tears in her eyes, that a vial of laudanum, as we had suspected, 
was found in a little pocket within the other pocket, and which 
w r as made for the express purpose of holding it. Though the 
laudanum was found as just stated, the manner of its exhibition 
was still a mystery, especially as we were convinced, from what 

Mrs. herself said, as well as the declarations of the young 

woman, that the nurse had never been left alone, even for a mo- 
ment, with the child. It was, however, now certain in all our 
minds that it had been given by some stratagem or other; and, 
with the hope of detecting the method, we inquired of the young 
woman whether she had ever seen her make any applications to 
her nipples, for any purpose, or under any pretext whatever? 
She said she had; she had seen her apply the mouth of a vial 
containing the tincture of myrrh to her nipples, every day, for 
the purpose as she, the nurse, had said, of hardening them. The 
mystery was now explained — it was laudanum, and not the tinc- 
ture of myrrh, which had been thus ingeniously applied; and by 
permitting it to dry from time to time, a sufficient quantity of 
opium was accumulated upon the nipple to cause the deep sleep 
in which the child was found. 

This nurse had been permitted to visit her own child, every 
afternoon, when the nurse-child was not awake, to require her 
attention ; she, accordingly, procured a regular sleep at this time 



OF PHYSICAL INJURIES. 61 

of day by the aid of laudanum, that she might get abroad with 
certainty. 

167. The selfishness of a nurse may show itself in other ways ; 
namely, by eating and drinking such articles as she knows will 
disturb the stomach and bowels of the child, but has not suffi- 
cient feeling to give up the gratification of her own appetite for 
its benefit. The child becomes tormented by colic, or other 
affections, which are only relieved by repeated doses of lauda- 
num, until a habit is created, which it is almost impossible to 
break — the consequences of such conduct are well known to every 
body. 

168. Again, the life of the child may be forfeited, in case of 
its illness, by the too free indulgence of the nurse's appetite — in 
many instances it is of vital importance that the quality of the 
milk should be altered by a change of diet imposed upon the 
nurse — but will the selfish woman conform rigidly to the instruc- 
tions of the physician for this purpose? Tansillo decides that 
she will not: — 

f 
11 Sick, pale, and languid, when your infant's moans. 

Speak its soft sufferings in pathetic tones, 

When nature asks a purer lymph subdued 

By needful physic, and a temperate food; 

Say, will the nurse her wonted banquet spare, 

And for your infant stoop to humbler fare ? 

Or with her pampered appetite at strife, 

One potion swallow to preserve its life? 
. Self her sole object, interest all her trade. 

And more perverse the more you want her aid." — Tlie Nurse, p. 51. 

169. But, perhaps, nothing displays the selfishness of the nurse 
in such strong relief as the tyranny with which she attempts to 
govern the whole house — every body, and every thing, is laid 
under contribution, that her wayward pleasures may be gratified 
— if she frown, is sullen, angry, or capricious, every thing must 
be yielded, that her perturbed spirit may be appeased; and ner 
demands increase in proportion as they may have been grati- 
fied. 

Sect. V. — By the Propagation of an active or occult Disease. 

170. "We have had many opportunities of witnessing injuries, 
arising from this cause, when it was too late to prevent them; 
nor could they have been detected at the proper moment, what- 
ever may have been the skill of the physician, or the vigilance 
of the parent. Diseases of the skin, as the itch, some species 
perhaps of tetter, have been so frequently propagated, as to be- 
come familiar to the observation of every body; and in two in- 
stances, we had the immediate care of those who had received, 



62 OF THE MORAL INJURIES. 

from the nurse the most loathsome and horrible of all diseases: 
it was communicated not only to the children who were at the 
breast, but also to four older ones. 

171. These cases are not so rare as we might hope, especially 
on the continent of Europe. They are more rare in Great Britain, 
and still more rare in this country. Rosenstein, in his treatise on 
the diseases of children, relates, that in a respectable family in 
Stockholm, the father, the mother, three children, the maid-ser- 
vant, and two clerks, were infected with the venereal disease, by 
a nurse who was admitted into the family without previous inquiry 
into her character. 

172. How far this last disease may be communicated by merely 
drawing the milk of a woman who may have it in a secondary 
form, we are not exactly prepared to say, from our own experi- 
ence — there is much testimony in favour of such a transfer ; but 
there is much reasoning against it; yet there is on£ concession 
all will be willing to make — namely, that there is a risk in em- 
ploying a nurse so circumstanced. 



CHAPTER XII. 

II. OF THE MORAL INJURIES. 

173. The moral influence the nurse may have upon the child 
every body is aware of: the parent may attribute to her almost 
whatever the child may become in after life. On this account, 
the moral habits of the nurse are almost paramount to her ca- 
pacity to afford the proper nourishment — the hero, and the pol- 
troon ; the liar, and the man of honour ; the timid, and the daring ; 
the superstitious, and the rational; the modest, a and the pre- 
suming; the amiable, and the froward; the humble, and the arro- 
gant ; the passive, and the active — all have received the first im- 
pulse of character in the nursery. 

174. Baldini, as quoted by Struve, relates the case of a little 
girl, of seven years old, who had an irresistible desire to drink 
brandy, which she had contracted by drawing the breasts of a 
nurse who was an habitual tippler. If this be so, more faith 
may be given to the story of Nero and his nurse than is com- 
monly bestowed upon it. 



OF DRESSING, ETC., THE CHILD. 63 



CHAPTER XIII. 

OF DRESSING, ETC., THE CHILD. 

175. Our fifth direction (105) recommends that a mother should 
pay attention to the washing, dressing, and undressing of her 
child. This advice, at first sight, might appear to be imposing 
upon her a task of great labour; but it is not so — and if it were 
even much more so than it is really found to be, it should never- 
theless be considered as one belonging to her. She need not do 
the mechanical part of this important operation; but she should 
never withdraw her eye from her child while it is performing. 
The operation of dressing properly consists in the washing and 
putting on the clothes of the child — and, first, 

Sect. I. — Of Washing. 

176. There must necessarily be a period at which the mother's 
absolute presence cannot be expected at the washing of her child; 
but there is none at which she cannot make her wishes known 
upon this point of discipline. But as young mothers are rarely 
well instructed upon this point, we shall offer a few rules, which 
she can either adopt in their full extent, or so modify, as may 
best suit her particular case, or as future experience may suggest. 

177. The object of washing is to remove from the surface of 
the body all impurities it may have contracted, either visible or 
invisible, by the aid of water and soap. 

178. A newly born babe has always attached to its surface an 
impurity, which it brings with it from its mother's womb ; this 
substance most resembles an imperfect, soft fat; it is very tena- 
cious, and oftentimes is of very difficult removal. A question 
has arisen whether this should be removed. A certain German 
professor, some years ago, insisted it should be let alone, as it 
would, in the course of a few days, become dry, and peel off 
spontaneously. This is strictly true; but does this fact prove the 
propriety of permitting it to remain on the surface of the body? 
Certainly, it does not; and for the following reasons: 

179. 1st. When this substance has not been cleansed from the 
body, either from careless washing, or from the difficulty found 
in its removal, it has always produced a very disagreeable smell. 

180. 2d. When it has been suffered to remain from any cause, 
it has hardened itself so much as to give pain from its mechani- 
cal irritation. 

181. 3d. When it has been suffered to dry, it has remained, 
in some instances, so long, as to leave the surface under it so 



64 OF DRESSING ETC., THE CHILD. 

severely excoriated, as to require particular attention for some 
days. 

182. For these reasons, we are persuaded it is highly proper 
that this substance should be removed from the body of the child 
as completely as possible at the first washing. It is, also, pro- 
per to point out the best mode of doing this. Every part of the 
child should be smeared with fine hog's lard before water is ap- 
plied. This being done, the child should then be carefully 
washed with lukewarm water, and fine soap. The nurse will be 
much aided in this operation if she employ a piece of fine flan- 
nel, or sponge, instead of linen, or cotton rag; as the former 
will detach the offensive substance much more readily than the 
latter. 

183. Great care should be taken to remove this substance from 
every fold of the skin, and especially from the joints, groins, 
armpits, &c, that excoriations may not follow from the omission. 

184. We italicized the words, "lukewarm water and fine soap," 
that we might give our opinions upon each of these means — 
and, first, of lukewarm water. We have ever held it proper 
to use the water a little warmed for new-born children, as the 
application of cold water is, in our opinion, too severe. Let it be 
recollected that the child has been suddenly removed from a tem- 
perature of at least 98° of Fahrenheit's thermometer, to one al- 
most at all times lower and very often very much lower; that 
this transition has a very powerful effect upon its nervous, its 
muscular, and its sanguiferous systems. The first is known by 
the suddenness and violence of its cries; the second, by the very 
powerful contractions and relaxations of its little limbs and body; 
and the third, by the rapidity of its circulation. 

185. It must also be kept in mind that warmth is a sine qua 
non to a newly born child ; for the heat it brings with it into the 
world is nothing but the heat of communication, or, in other 
words, that which it derives from its mother ; and would be very 
quickly dissipated, if not carefully cherished by external means. 
For to acquire heat of its own, if we may so term it, requires a 
free use of its lungs, and the complete establishment of its circu- 
lation, for some time. Then, why should its little sum of warmth 
be wasted in conformity to an hypothesis ? for, it is nothing more, 
when cold water is used with a view "to make the child strong." 
And we will now ask, for the sake of information, can any one 
reason be given why a child should acquire strength by the use 
of cold water? We shall have occasion to advert again to this 
subject. 

186. We have repeatedly seen it require the lapse of several 
hours, before reaction could establish itself, 1 during which time, 

1 I was informed, within a few days, by an experienced nurse, that, upon one 
occasion, where it was insisted on by the father that the child should be washed 



OF DRESSING, ETC., THE CHILD. 65 

the pale and sunken cheeks, and the livid lips, declared the 
almost exhausted state of its excitability. We are persuaded 
we have known death itself to follow the use of cold water, for 
the first washing of the child. It is true, in these instances, the 
children were born feeble, and required but little of improper 
management to destroy them ; but it should be recollected, had 
their little powers been well husbanded, they might have been 
restored to good and perfect health. 

187. Rousseau condemns the application of warm water to 
even the new-born child; or, at least, he says, "Warming the 
water may be as well dispensed with; as among many different 
people the children are taken immediately after their birth and 
bathed in the river or sea." This appears to us an act of 
necessity, rather than of choice ; since few, we believe, do this, 
but people in savage life, where, from their erratic habits, few 
opportunities are offered for this kind of ceremony. Indeed, a 
people of this kind rarely have the conveniences for the purpose 
of heating water; therefore, a necessity must not be mistaken 
for a wise speculation on future good health. But, if this were 
even strictly true, what does it prove ? Is there any evidence 
that the children thus treated are of better health than those 
managed in the opposite mode? There is no such evidence; 
for, were it even proved that the health of a people who, from 
birth, used cold water, was better than those washing with warm, 
we might justly doubt whether this increase of health depended 
upon this circumstance alone. 

188. Indeed, Rousseau himself seemed to answer this question 
in the negative, since he attached so much consequence to a 
country life, to uniform employment in the open air, to a free, 
and active exercise of the body in the various duties of the hun- 
ter, the shepherd, and the farmer. 

189. We have every reason to believe that catarrhal affections 
have been produced by the use of cold water, especially in very 
young children, from which the poor little creatures have escaped 
with much difficulty. Now, as serious evils may arise from ab- 
lutions of cold water, and as we have never heard it even sua:- 
gested that immediate injury has followed the use of warm, the 
line of conduct to be pursued would seem to be very easy to 
make choice of. 

190. Some, with a view to improve the quality of the water, 
add brandy or other liquors to it; or, if they do not mingle these 
with the water, they very carefully wash the infant's head with 
some one of them, for the purpose, they say, of strengthening it. 
This practice, though not so extensively injurious as the one just 

in cold water, that the little creature did not recover its warmth for twenty-four 
hours, though every expedient was employed for this purpose— the washing with 
cold water was not repeated of course. 
5 



66 OF DRESSING, ETC., THE CHILD. 

spoken of, is nevertheless decidedly improper. There cannot 
be any possible necessity for thus violently stimulating the poor 
babe — thus do they "banish simplicity from even dressing a 
new-born child." 

191. And, 2dly, of "fine soap:" this direction should be 
carefully obeyed: a neglect of it is sometimes attended by great 
injury to the child. There is a brown, and highly stimulating 
soap in common use, called "rosin soap," because this substance 
enters very largely into its composition : this, if applied in strong 
solution to the tender skin of a new-born child, will very fre- 
quently abrade the cuticle to a very large extent; it should, 
therefore, never be employed. It is better to wash the child 
with plain warm water, than have recourse to this soap. 

192. During the whole process of washing, the child should 
be exposed as little as possible to a current of air; and, if the 
weather be cold, it should be dressed near the fire. 

Sect. II. — Of the Dress of the Child. 

193. The dress of the child should always be made subservient 
to comfort. If this rule be acted upon, it will be found to con- 
sist, 1st, in such arrangements of it as shall sufficiently protect 
it against cold, 1 and 2dly, to insure it against all inconvenient 
and injurious pressure and restraint, as well as producing too 
much heat ; therefore, the cruel practice of swaddling should be 
for ever laid aside. 

194. For this absurd practice, it would, perhaps, be difficult 
to assign a reason ; it probably, however, arose from the inroads 
made by the rickets upon the proper form of the human limbs — 
mistaking the effect of disease for a defect of nature ; and thus 
applying a partial remedy for the morbid condition of the whole 
constitution. In times of ignorance, when the care of women 
was entirely confided to females, this injurious practice may have 
originated in a false theory ; and it was certainly perpetuated 
by the designing midwife. For, though every child was not born 
with a disposition to rickets, yet it is probable that these selfish 
women persuaded their patients that the limbs of all children 
would become so, if not guarded against by proper management. 
This opinion seems in part confirmed by this practice being in 
a degree abolished, as soon as midwifery became generally prac- 
tised by men ; for we never hear of an accoucheur performing 
this terrible ceremony for the poor child. 

195. Buffon says, "With us (in France) an infant no sooner 

1 It is a very common error to suppose the tighter the clothes are wrapped 
round the child, the warmer it will be kept; but this is not so, for warmth will 
always be increased by leaving the child's limbs rather free, as its motions then 
will contribute to its warmth. 



OF DRESSING, ETC., THE CHILD. 67 

leaves the womb of its mother, and has hardly enjoyed the liberty 
of moving and stretching its limbs, than it is clapped again into 
confinement. It is swathed, its head is fixed, its legs are stretched 
out at full length, and its arms placed straight down by the side 
of its body. In this manner, it is bound tight with clothes and 
bandages, so that it cannot stir a limb: indeed, it is fortunate 
that the poor thing is not muffled up so as to be unable to breathe ; 
or, if so much precaution be taken as to lay it on its side, in 
order that the fluid excretions, voided at the mouth, may descend 
of themselves ; for the helpless infant is not at liberty to turn 
its head to facilitate the discharge." 1 

196. Can any thing be running so entirely counter to the dic- 
tates of nature ? Let us consider the poor infant folded up in 
the smallest convenient form in its mother's womb, for the 
period of nine months; and then let us watch its movements as 
soon as it is free; and we shall at once be convinced, by the 
stretching of its little limbs in every direction, how much it en- 
joys its liberty. 

197. Analogous to the unnatural restraint imposed upon the 
limbs by bandages, we may reckon the common practice of 
even the present day, of pinning the ends of its garments close 
up to the feet of the child ; thus preventing all movements of 
its limbs. This should be guarded against by the mother for- 
bidding the nurse to dress the child after this fashion. If the 
ends of the clothes must be turned up, let sufficient room be 
given for the exercise of the child's limbs. In the same way, 
all motion is prevented to the arms by their being confined by 
a napkin, when the child is laid down ; this is done under the 
specious pretext of preventing the child from scratching itself 
with its nails, as it cannot command the direction of its hands. 

198. It would be useful to the poor infant to have the use of 
its limbs, even at the expense of an occasional scratch from its 
own nails; since, by their exercise, they would become strength- 
ened, and, in a short time, the child would learn to direct them 
properly by a gradually increasing experience. We would, 
therefore, forbid every restraint to the motion of the limbs, 
body, and neck of the child ; and thus permit them to exercise 
their little muscles in any direction or degree they might choose. 
In cold weather, the arms may be covered to encourage warmth, 
but they should never be fixed down. 

199. It is to this freedom of the limbs that the child is in- 
debted for its increase of strength, and its eventual power to 
walk ; and to it does it owe the preservation of the due vigour of 
the antagonizing muscles. For when but one set of muscles is 
employed, the antagonizing set becomes weakened; and, if too 

1 Hist. Nat. torn. iv. 190, 12mo. 



68 OF DRESSING, ETC., THE CHILD. 

long persevered in, are sometimes rendered even useless. "We 
once saw a child, who had been made to nurse itself almost from 
its birth, lose the power of the extensor muscles of the legs, by 
being obliged to sit for many hours together in one spot upon 
a hard floor. This child could never stretch its legs sufficiently 
straight to learn to walk, and died a cripple at the age of seven 
years. 

200. Proper attention has rarely been paid either to the 
materials or the form of the articles of clothing, for a new-born 
child. They have, generally, been made of the same kind of 
stuff, whether the child be born in winter or in summer — this 
surely cannot be required. In general, however, the error has 
been on the safer side; for if the child have suffered, it has 
rather been from a deficient quantity of clothing. But errors 
of every kind should be removed when practicable; therefore, 
we should not have more clothing heaped upon the child than 
shall be necessary to protect it against the existing cold. 

201. This adjustment, however, requires much care, and 
should be effected by those of good judgment, though not pre- 
cisely for the reasons assigned by Dr. Buchan, who says, 1 that 
"every child has some degree of fever after birth; and, if it be 
loaded with too many clothes, the fever must be increased often 
to such a degree, from the concurrence of other causes of heat, 
as to endanger the life of the child. Even though no fever 
should be excited, the greatest debility must be the consequence 
of keeping the child in a state of perpetual waste by excessive 
perspiration. Besides, in such a condition, the child is liable to 
catch cold upon exposure to the least breath of air; and its 
lungs, relaxed by heat y and never sufficiently expanded, are 
apt to remain weak and flaccid for life, so that every cold will 
have the most alarming tendency, and probably terminate in 
asthma or a consumption." 

202. The Dr, has really drawn a frightful picture of the effects 
of too much clothing upon a young child ; but it is one we cannot 
recognise from experience, nor acknowledge from theory. We 
admit that should the child be so abundantly clothed, as to keep 
in a constant state of perspiration, there might be a risk of its 
catching cold upon exposure, or much weakened. But we are 
of opinion, if mothers should take the alarm from this represen- 
tation, they might do much worse, by running into the contrary 
extreme; and Dr. Buchan himself would confess too thin clothing 
might be attended with worse consequences than too thick. Be- 
sides, we do not agree with the Dr. in the premises he starts with, 
namely, that "every child has some degree of fever after the 
birth." 

1 Advice to Mothers, p. 110. 



OF DRESSING, ETC., THE CHILD. 69 

203. We should be very careful how we admit this position, 
as it would lead to very wrong practice. That a new-born child, 
like another individual, might have fever as an accidental cir- 
cumstance, we admit; but, as a necessary consequence of its 
birth, we deny — first, because it would seem an extraordinary 
arrangement of nature, that every child should be ushered into 
existence in a state of disease; for fever is disease; and a disease 
of a formidable kind; 2dly, we have never witnessed this, as a 
sequence of birth. Therefore, withholding a sufficiency of clo- 
thing, with a view to counteract, or to not augment an imaginary 
disease, would, to say the least, be idle. 

204. That new-born children may be improperly dressed, and 
improperly managed after they are dressed, we believe, nay, 
know: but the state of perspiration which the Dr. so much 
dreads is owing, we believe, almost always, in cold weather, to 
their being placed under too many bed-clothes. On this account, 
we would caution against both extremes ; but not because the 
child has fever ; nor from an apprehension of the evils which 
are supposed to follow a state of perspiration. As this is a 
matter of consequence, as every truth is that is connected with 
the welfare of infants, we shall say a few words upon the sup- 
posed consequences of this over-dressing. 

205. The doctor says the child is "liable to catch cold upon 
exposure to the least breath of air:" this is admitted, if the child 
be in a state of perspiration, and be improperly exposed; but 
this would be the case, did the perspiration proceed from an over 
quantity of bed-clothes; and as it would be important to deter- 
mine from which of these sources the evil proceeded, it would be 
well to give it a fair investigation ; and to ascertain, if possible, 
to which of the causes the error belongs. Therefore, should 
the child be moist, though exposed to the air, it might justly be 
attributed to a solution of fever; but if it only perspired when 
closely covered, we would be certain it proceeded from an excess 
of clothing. We have, however, considered it sufficiently diffi- 
cult in most cases to excite perspiration upon the skin of a new- 
born child, by almost any means ; and for this plain reason — it 
is some time before the vessels upon the surface become suffi- 
ciently active, and filled, or the circulation sufficiently powerful 
to produce this effect. Examine the skin of a new-born child, 
and you will find it almost constantly cold, unless well protected 
by clothing made of materials which are bad conductors of heat 
— and hence the absolute necessity of maintaining this condition 
by suitable means. 

206. The Dr. also says, that "the child's lungs are relaxed 
by heat!" If this be so, how is it possible to prevent it? If 
heat be improper to the lungs, all animals that have hot blood 
must be precisely in the same situation! for the Dr. would not 



70 OF DRESSING, ETC., THE CHILD. 

deny that warmth is essential to the existence of man ; and if 
this be so, the lungs, like every other internal part, must have 
an equal temperature, and no more: now, how a temperature, 
which scarcely varies a degree at any season of the year, and 
which is natural to the human body, and inseparable from it in 
the living state, shall produce relaxation of the lungs, we cannot 
possibly understand. 

207. He farther states, "they (the lungs) are never sufficiently 
expanded, and are apt to remain flaccid for life." We would ask, 
why the lungs are never sufficiently expanded? Because the 
lungs are relaxed by heat, we suppose must be the answer from 
the premises ! Now, it would seem from this, that our notions 
upon the expansion of the lungs must have been wrong, since 
heat is unfavourable to it, by producing relaxation of them. We 
have often heard of, and we believe we have seen, the sudden 
application of cold interrupt the full expansion of these bodies ; 
but we have to learn that heat does so, by producing relaxation 
in them. To our mind, this relaxation, if it exist, should favour 
expansion, since it implies less resistance. 

208. In winter, or even in cool weather, flannel must form a 
part of the child's clothing; especially their little shirts and 
petticoats ; but this should be of such fineness as not to oppress 
either by its weight or its thickness. It should always be of the 
white kind, where the circumstances of the parents will permit 
it — not that the first cost of the white need be greater than that 
of the coloured, but because it will, for the sake of the eye, re- 
quire to be more frequently changed, as it will more readily show 
any dirt that may attach to it ; but for this very reason, it should 
be employed whenever it is practicable. Another reason may 
also be assigned ; the white can always be procured of a finer 
quality, which sometimes is desirable. 

209. There is a very common error upon the subject of flan- 
nel, which deserves to be corrected ; namely, that it can remain 
longer dirty without doing mischief by its filth, than any other 
substance; but in this there is no truth — flannel, from its very 
texture, is capable of absorbing a great deal of fluid, which it 
will retain so long, if permitted, as to allow a fermentative process 
to go on, and give rise to the extrication of some deleterious 
gases; therefore, flannel should not be worn even so long, on this 
very account, as linen substances. The principal advantage in 
the use of flannel is, its non-conducting property of sensible heat 
— it is, therefore, well calculated to protect the body against the 
too rapid escape of this important fluid. 

210. Agreeably to these views flannel should be used whenever 
it will be proper to accumulate heat, by preventing its too rapid 
dissipation from the body; it should, therefore, be employed 
precisely in the proportion that these ends require. But it will 



OP DRESSING, ETC., THE CHILD. 71 

be readily seen, that no precise quantity can be directed ; since 
the degree of necessity will be constantly varying as temperature 
may alter, or as constitution and period of life may change. As 
a general rule, it may, however, be observed, that the younger 
the child is, the more of this article is required ; but it should 
never be in such quantity as to create a vapour bath. 

211. There is another operation of flannel that is highly valua- 
ble, especially in this variable climate; and its agency in this 
respect may be considered as one of almost indispensable neces- 
sity — it is its protecting power against sudden reductions of 
temperature. By virtue of its non-conducting power, the system 
is saved from a prodigious expense of caloric, or heat, at a time 
when its sudden escape might be attended with effects of the 
most serious kind — the advantages of flannel in this respect are 
familiar to every one ; for every body adopts the practice, with- 
out exactly understanding the principle on which it is founded. 
Again, it powerfully guards the body against the cooling effects 
of evaporation, when in a state of perspiration ; and by prevent- 
ing its too sudden escape, it keeps a considerable portion of heat 
constantly applied to the surface of the skin, by means of this 
vapour; and thus hinders it from leaving the body too suddenly. 

212. Flannel may also be regarded as a very pleasant and 
extensive " flesh brush;" by constantly giving to the skin a 
gentle and an agreeable irritation. By this means the insensi- 
ble perspiration is freely maintained; while all the evils arising 
from a check of the sensible, are very much guarded against. 

213. It must nevertheless be admitted, that the utility of 
flannel has its limits ; beyond which its employment should not 
be urged. Flannel may be improper, 1st, where it excites too 
much perspiration, as in young children, sometimes during the 
extreme heats of our summers — when this is observed it should 
be removed, and a similar garment of muslin, or even linen, 
should be substituted. The flannel should, however, be imme- 
diately replaced, whenever an alteration in temperature may 
render this proper. Indeed, the only proper direction that can 
be given for the dressing of the children during our summers, 
is to vary the clothing with the variations of the thermometer. 
This, it is true, may occasion some additional trouble to the pa- 
rent; but the observance of it, it should be remembered, gives 
additional security to the health of the child; for we are entirely 
convinced that very young children suffer extremely, and are 
sometimes even rendered ill, by their bodies being too much 
loaded with flannel. 

214. 2dly, Flannel may also be improper from idiosyncrasy — 
this should be carefully attended to ; as the child has been known 
occasionally to suffer much from this peculiarity. It may readily 
be detected, by the child almost constantly expressing uneasi- 



72 OF THE BELLY BAND. 

ness, without any obvious cause; and by an efflorescence spread- 
ing itself over the body, which immediately disappears so soon 
as the flannel is removed. 

215. 3dly, Flannel may also be improper during a febrile 
condition of the system ; it should, therefore, always be removed, 
when it may be desirable to lower the temperature of the skin. 
We are well aware that this will appear extraordinary advice 
to many; and there may be even strong prejudices against the 
practice. But we fear no reproach upon this head; as it has 
been justified, a hundred times, in our own practice. The fear 
of " catching cold," as it is called, should not prevail against it, 
since you cannot ingraft a slighter disease upon a stronger. 1 

Sect. III.— Of the Belly Band. 

216. This useful appendage to the child's dress should be of 
flannel, but it should be made single, it should be worn until 
the child is at least four months old, or even for a longer period, 
if the child be feeble, or has a tendency to umbilical hernia. 
This article is of great importance, and should never be omitted ; 
but care is required in its application, that it do not produce 
the evils it is intended to prevent. The object of a belly band 
is to give a general support to the abdomen, and a particular 
one to the navel. The propriety of using it for the first object, 
will be obvious to every body at first sight. It protects the 
external covering of the belly from being suddenly and partially 
distended, in the actions of crying, coughing, and sneezing; and 
by this means, pain, or more serious evil is prevented. 

217. But the necessity and utility of the second, if equally im- 
portant, is certainly not as well understood. The umbilical cord, 
by means of which the child is nourished during its residence 
within the uterus, is composed of several vessels, which enter in- 
to, and depart from, the belly. The passage of these vessels re- 
quires a hole entirely through the covering of the bowels, which, 
for the most part closes very quickly and soundly, after the sepa- 
ration of the navel. But several circumstances, on the part of 
the child, may interrupt this natural process; and, when these 

1 It may not be amiss to suggest, not only the utility, but the absolute luxury 
to the child, of friction upon its abdomen, with the bare warm hand, for a minute 
or two every time it is dressed. This exercise is so grateful to the child, that it 
never fails to express its delight by smiles, cooings, and the stretching of its limbs. 
We would, therefore, always recommend this practice, since it not only delights 
the child, but also promotes the healthy action of its bowels. 

In summer, flannel is frequently found to be oppressive, as well as irritating. 
In such cases, we have lately found silk shirts to be highly grateful as well as 
useful. We would, therefore, recommend its employment in all instances in 
which the flannel is found to disagree, or where it is thought to be ineligible. 
The substance known by the people of trade under the name of Canton, is ex- 
cellently well adapted for the purposes here proposed. 



OP THE BELLY BAND. 73 

happen, they give great liability to a portion of the bowels, or 
of the omentum, to be forced through this imperfectly closed 
opening from any strong and sudden conquasatory motion, as 
crying coughing, sneezing, or straining. 

218. The circumstances, on the part of the child, which may 
give rise to, or increase this liability to a " rupture " at this part, 
are, 1st, an unusual size of this opening, as an original confor- 
mation ; 2dly, the want in the part of a healthy disposition to 
close; 3dly, an interruption being given to the natural process 
of closing, by the crying, &c, of the child, forcing the intestine 
or omentum frequently against it. 

219. It will follow that this part, being weak from its very 
organization, will require a steady and continued protection, that 
the accident of "rupture " may not take place. 

220. For this purpose the belly band has been used from time 
immemorial; but its mode of action is not well understood by 
those who apply it to new-born children. It is wrongly ima- 
gined that the tighter this bandage is drawn over the part the 
greater is the security against the evil it is intended to prevent 
— than which no greater error can exist, as will be evident to 
any one who will consider the following account of the struc- 
ture of these parts. 

221. 1st, The cavity of the abdomen may be considered as 
completely filled, or occupied by its contents ; 2dly, that the ab- 
dominal cavity is formed without any absolute outlets, or com- 
munications with the external air; but has openings leading to 
other cavities, as those of the scrotum in males, but into which 
it is not intended, as a natural arrangement, that any portion 
of the abdominal viscera shall enter ; and also the one already 
described as existing at the umbilical ring. 

222. Now when the capacity of this cavity is diminished, or 
severely restricted as it necessarily must be by the diaphragm 
being forced powerfully downward, and severely pressed on all 
sides by the abdominal and lumbar muscles, as must necessarily 
happen in the actions of crying, sneezing, coughing, or straining, 
that the contents of this cavity must be constrained, and pow- 
erfully pressed against every part and portion of its internal 
face; and if there be any one portion of the surface weaker than 
another that part must necessarily yield, if the force be greater 
than that part can sustain. It will, therefore, follow, as a mat- 
ter of course, that the scrotal and the umbilical openings just 
mentioned, being naturally weaker points in this cavity, they 
will and must yield, when the impulses just named shall be great- 
er than the powers of resistance. 

223. From what has been said, it will readily be admitted that 
any arrangement of dress which shall diminish the cavity of the 
abdomen, must have a tendency to do mischief, in the way we 



74 OF THE GENERAL DRESS OF THE CHILD. 

have just pointed out; therefore, the belly band may become an 
agent of this kind, if not properly applied — hence it becomes an 
important part of a mother's duty to attend, at each dressing of 
the child, that the band be not too tightly drawn. 

224. Evils of a lesser kind oftentimes follow the improper ap- 
plication of this article of dress ; namely, pain, arising from com- 
pression, and colics, from the want of room for the bowels to 
expand. The inconveniences enumerated above, as arising from 
too strict an application of the belly band, suggest the impor- 
tance of this article being as elastic as will be compatible with 
security — we, therefore, would direct that it should be made of 
a piece of flannel, cut "bias," as the women term it, in order 
that it may possess this property. 

225. The disease against which we have been suggesting a 
prevention, so far as dressing maybe concerned, is of more fre- 
quent recurrence than could well be imagined by one who had 
not made it a subject of inquiry; and, when it takes place, is 
of much more serious consequence than might, at first sight, be 
supposed: therefore, to prevent it is of the first consequence. 



Sect. IV. — Of the general Dress of the Child. 

226. The other articles of a child's dress may be regulated 
in such a manner as will give sufficient security against too low 
a temperature in winter, or as shall not oppress in summer: 
therefore, the petticoats for winter, fall, and spring, should be 
made of flannel, and of such length as shall cover their limbs 
with certainty. Flannel may, however, be occasionally useful 
in summer, especially on sudden changes of the weather, and 
should always be resorted to upon such emergencies ; for there 
can be no greater error committed in dressing a child, than 
to regulate its clothing exclusively by the almanac, or, some- 
times, even by the thermometer. The feelings alone should de- 
termine the quantity and quality of them, during either midsum- 
mer or winter. If these be made the rule, we shall find it very 
often important to vary the articles of clothing, in our unsteady 
climate, two or three times within four and twenty hours. 

227. The length of the child's clothes is, by no means, a 
matter of indifference. After it has arrived at its eighth or 
ninth month, they should be shortened, so as to leave the feet 
and ankles free. By this plan, the child will use its limbs earlier, 
and to more advantage, since they will not be fettered by the 
restraint of long dresses. The muscles will acquire more firm- 
ness and tone, and be more obedient to the command of the will; 
they will also be exercised regularly, and the flexors and exten- 
sors will have their just proportions of power, so that when the 



OF THE GENERAL DRESS OF THE CHILD. 75 

child begins to walk, it will be able to balance itself much sooner, 
and more successfully. 

228. Some, perhaps, will object to this arrangement, espe- 
cially in winter, from an apprehension that the feet aiui legs 
may suffer from cold — but this objection is easily removed by 
covering these parts with their appropriate garments. 

229. We are aware that this last objection is not in conformity 
with some writers upon this subject. We know that stockings 
are forbidden by them for two reasons ; 1st, because they will 
injure the child by becoming wet ; and, 2dly, because they will 
make it too tender. 

230. To the first we would declare, that upon this principle, 
the child should have no clothing whatever, since all is exposed 
to the same accident. The diapers, the petticoats, &c, should 
be abolished, since they must often become wet in the course of 
the day; yet we hear nothing of injuries arising from this source. 
When these articles are wetted, care is taken that they are dried 
before they are again used, or their places supplied with fresh 
articles ; and why should not the same attention be extended 
to the stockings? As regards the second objection, the reasons 
we have urged against all unnecessary exposure of the person 
of the child, will apply here ; and, therefore, we shall not re- 
peat them. 

231. Shoes are condemned, because they are said, 1st, to 
cramp the feet and embarrass their motion ; 2dly, that the child 
does not learn to walk so early as when they are exposed. These 
are very far from being solid objections to the use of shoes, since 
the first may be removed by their being made large, and of the 
most pliant materials; and as they afford protection from cold 
and security against accident, when the child is placed upon the 
floor, we are decided advocates for their employment, especially 
upon carpeted floors, where pins, needles, or other sharp sub- 
stances, are very often effectually concealed, by their being buried 
in the substance of the carpet. 

232. The second objection has, perhaps, less force than the 
first ; since we have ever held the opinion that no advantage is 
gained by a precocious power to walk. Indeed, we hold this to 
be very often injurious, especially to such children as may be 
disposed to rickets. We shall have occasion again to mention 
this subject. 

233. We have said that the shoes may be so constructed as 
to do no injury to the child. This is strictly true, and should 
always be conformed to; but the plan proposed (we believe, 
originally, by Faust, in his Catechism of health,) merits the at- 
tention of every parent; namely, having shoes made upon two 
different lasts, one for each foot, as is now pretty generally done 
in this city. We object very much to the advice of Struve upon 



76 OF THE GENERAL DRESS OF THE CHILD. 

this subject — he recommends children to lay aside shoes for a 
short period at a time, that the feet may be better expanded. 
This is certainly bad advice; as most children would be subject 
to serious colds, by this plan, if not to dangerous disease. 

234. In winter and in cool weather, we follow the proper plan 
almost instinctively, as regards clothing; for we accommodate 
the quantity by our feelings, without regarding the state of the 
mercury in the thermometer. Precisely the same should be 
done in summer — the relative heat, or cold, should be our 
guide. 

235. The principal articles of clothing are to be made of fine 
flannel — they are generally called the under clothes — fashion, 
caprice, or fortune, may regulate the rest, provided the garments 
for the feet and legs are excepted. We hold it to be of great 
importance that both of these be kept warm in winter ; and the 
feet even during summer. We, therefore, direct measures to 
protect these parts of even very young children. We shall have 
occasion, by and by, to revert to this subject. 

236. There is, however, a constant necessity to guard the 
child against the accidental and partial application of cold from 
wet, which is always occurring, from the very nature of things. 
The child should, therefore, be dried as quickly as possible after 
it may have become wet, by a speedy renewal of the diaper. A 
monstrous error prevails upon this subject; an error every way 
calculated to produce great disquiet and inconvenience, if not 
positive disease. It is imagined, that inuring them to wet con- 
tributes to the future health of the infant, or, in other words, 
that it must remain wet and cold, that it may become hardened 
in constitution by this filthy process. The absurdity of this 
practice is at once exposed, by asking, is there a mother who 
would apply cold, wet clothes to her child, with a view to hard- 
ening it, though she might be willing to let it wallow for a long 
time in its filth? 

237. It may, however, be said, these are not parallel cases ; 
for the urine of the child can do no harm, as it is salt water. 
We admit it to be saline— what then ? Will any woman apply 
cold, salt water to her child, for the purpose, and in the manner, 
we have just mentioned ? But it may be said, the water is warm 
when it touches the child, and becomes cold afterwards ! So 
much the worse — but will any rational mother apply warm salt 
water to her child, and suffer it to grow cold, in expectation of 
benefiting it? We are certain, every one of proper feeling will 
say, No! 

238. The employment of too many pins in the dressings of 
the child, is also occasionally attended by much risk, especially 
when small ones are used — the latter kind should be banished al- 
together from the nursery, as they cannot ever be necessary, 



OF THE GENERAL DRESS OF THE CHILD. 77 

and may, as has frequently happened, be seriously injurious, by 
slipping into the folds of the skin, or joints of the child ; or they 
may create a great deal of immediate pain, by their partial pene- 
tration into the skin. The clothes of the child can readily be 
so arranged as to do away with the necessity of these articles; 
or, at least, the quantity may be very much diminished. When 
many are employed they are consequently liable to be displaced 
and may, consequently, wound the child. 

239. In general, nurses are in the habit of using from eight 
to twelve pins, for the dressing of the child; a quantity every 
way too great for even usefulness, did no risk attach to their 
employment; especially as the same ends can be completely an- 
swered by two, as was the regular practice in our own family. 
It is true, that to render so few efficient, strings or tapes must 
be used in their stead. The following is the mode employed: 
The belly band and the petticoats have strings ; and not a single 
pin is employed in their adjustment. The little shirt, which is 
always much larger than the infant's body, is folded on the back 
and bosom, and these folds kept in their places by properly ad- 
justing the body of the petticoat — so far, not a pin is used. The 
diaper requires one ; and this should be of a large size, and made 
to serve the double purposes of holding the folds of this article, 
as well as keeping the belly band in its proper place; the latter 
having a small tag of double linen depending from its lower 
margin, by which it is secured to the diaper by the same pin. 
Should an extraordinary display of best "bib and tucker" be 
required, upon any especial occasion, a third pin maybe admitted, 
to insure the well-sitting of the "frock" waist in front — this 
last pin, however, is applied externally; so that the risk of its 
getting to the child's body is very small, even though it become 
displaced. 

240. Especial care should be taken that needles be not used 
instead of pins; this substitution we have witnessed; and the 
risk in this case is much greater, as these articles have no heads. 
The most serious consequences have sometimes followed their 
use: I will relate a case every way in point. In the year 1798 
we were requested to examine the child of Mr. J. H. B. — -who, 
we were informed, had been for many months in ill health ; it 
occasionally suffered the most excruciating agony, without any 
evident cause, and which could not be relieved but by large and 
repeated doses of laudanum. The child was said to cry out vio- 
lently upon certain motions of its body, and especially, upon 
moving its right leg; upon the upper part of which there was a 
hard substance, which, upon being pressed, gave pain. 

241. The child was about two years of age; and had been 
always a very healthy one until the last preceding seven or eight 
months. At about this time, it was discovered to be fretful, 



78 OF THE GENERAL DRESS OF THE CHILD. 

feverish, and indisposed to exercise. It would, occasionally, 
scream violently; and would sometimes cease to cry as suddenly, 
without any evident cause. At other times, the pain would 
continue, until it was controlled by the use of laudanum. It 
lost its appetite, emaciated rapidly, and had more or less fever 
constantly. 

242. This was the history we received, upon our first visit, 
from the mother of the child. We found the child very much 
reduced, with considerable fever, and a profuse diarrhoea. We 
examined the part that was said to be painful, and found it to 
present a remarkable feel to the touch, as well as a singular ap- 
pearance to the eye. It was placed immediately upon the tuber 
of the right ischium, or that part of this bone on which we sit. 
It was considerably swollen ; so much so, as to offer a strong con- 
trast to the opposite one, which was very much emaciated. When 
this was pressed, the child would complain ; it was firm, and re- 
sisting; and if the fingers were made to grasp it, it seemed to 
contain another very firm and long tumour within it; giving the 
sensation to the fingers of a pretty long piece of bone, placed 
perpendicularly to the surface of the tuber of the ischium. 

243. We told the mother there was unquestionably an ex- 
traneous substance beneath the skin; the nature of which we 
could not pretend to determine ; but our impression was, it was 
a needle ; and that nature had set about a process for its libera- 
tion, in which she would certainly succeed in due time, should 
the child have sufficient strength to support the irritation neces- 
sary for this event: but this was a circumstance we very much 
doubted, as the child was not only very feeble, but very ill at 
that moment, from fever, lax, &c. We, therefore, proposed an 
operation, as a speedier and safer plan — it was instantly con- 
sented to. We made an incision with a scalpel, immediately 
upon the point of the inner tumour, from which issued about a 
tea-spoonful of a transparent, and pretty tenacious fluid, re- 
sembling the white of an egg ; but not quite so thick. Upon 
placing a finger upon the incision, and gently pressing it against 
the tumour, we felt a hard pointed substance directly in its centre; 
this was seized with a pair of forceps, and we drew from it a 
needle full two inches long. The wound was dressed with a little 
slip of sticking plaster, and healed in three days : the child from 
that moment had not an unpleasant symptom. The hectical 
diarrhoea ceased; as did the fever; and in a few weeks the child 
was restored to perfect health without the aid of any medicine. 

244. How or when this needle got possession of the child's 
system, could never be determined — it is presumable it was intro- 
duced by its being employed as a pin. 



OF FEEDING THE CHILD IN THE MONTH. 79 

Sect. V. — Of Changing the Child. 

245. There is a diversity of opinion respecting the necessity 
or propriety of frequently changing the dress of a child after it 
becomes wet. Upon this subject, there should be but one opinion; 
and this should become a maxim, from which there should be no 
departure; namely, that the child should never be long wet, or 
dirty, at a time. The healthiest children we have ever seen, 
were those on whom the greatest care was bestowed; especially 
when they were very young; and it is to that period we now 
have more particular reference. If frequent changing be not 
had recourse to when the child is wet, there can be no security 
for the continuance of health; every time it is permitted to re- 
main wet, it incurs the risk of taking cold, besides provoking 
inflammation, or producing excoriations; whereas, drying the 
child, as often as it becomes wet, will prevent these evils. 

246. But it should be well understood, when we speak of keep- 
ing the child clean, that we do not consider the repeated reap- 
plication of the same diaper, because it has been hung in the 
air, or before a fire and dried, as coming within our direction. 
There can be but two reasons for this filthy practice — laziness, 
and poverty. The first should never be considered as a valid 
excuse for employing the same diaper several times, nor will it, 
perhaps, ever be urged as one, in direct terms ; but it is, unques- 
tionably, the only one that influences upon this subject, where 
the second does not obtain, to render this, even in appearance, 
excusable. If the second reason exist, and the child have not a 
sufficient change, it were much better that it be without a diaper 

.from time to time, than have those returned to it stiffened with 
salt, and reeking with offensive odour. We have already advert- 
ed to the impropriety of keeping the child wet. 



CHAPTER XIV. 



ETC. 



247. Our fifteenth instruction, (106) is one of much importance 
to the future health and happiness of the individuals for whom 
it is intended; for no one_pf the errors we have attempted to 
correct, is so frequently and mischievously infringed. We have 
assumed as principles, and, as we think, upon broad and well 
established data — 1st, that the mother is the proper and only 
source from whence a child, until a certain period, should derive 
its nourishment; 2dly, that every woman, caeter is paribus, is able 



80 OF FEEDING THE CHILD IN THE MONTH. 

to furnish it; 3dly, that no other nourishment is so entirely pro- 
per as the milk of a healthy mother. 

248. If these premises be correct, the subject of feeding chil- 
dren within the month is reduced nearly to a prohibition, where- 
ver there is no exception to the above rules. Yet there may be, 
indeed there often is, a propriety in giving a young child some- 
thing to sustain it, when there is not a sufficiently early provi- 
sion made by the breasts of the mother for this purpose ; but it 
should consist of an article as near in composition as possible to 
the mother's milk. This object is readily obtained by a mixture 
of cow's milk, water, and loaf-sugar, in the following proportions : 
milk two-thirds, water one-third, and a small quantity of loaf- 
sugar. This may be given from time to time, until the mother 
is able to furnish a sufficiency; or, when she has not enough, it 
may be made to supply the deficiency. 

249. This diet alone should be made use of; for every thing 
else is not only less proper, but oftentimes absolutely injurious. 
No addition should be made, under the expectation of making it 
more fit, or more nourishing; for every such addition renders it 
less useful, if not hurtful — we therefore, proscribe every mixture, 
or combination, except the one just mentioned. We are aware 
we do not agree with the judicious Dr. Struve 1 upon this point — 
he directs, in cases of deficiency of milk on the part of the mother 
or nurse, that this want should be supplied by a " pap prepared 
of bread perfectly baked, or, what is still better, biscuits boiled 
in water, or fresh milk, to the consistence of thin gruel." We 
unhesitatingly declare we have ever found this to be a bad prac- 
tice ; and the Dr. himself would seem to bear testimony against 
it, in another place; 3 for he says, "Many mothers, and nurses 
in general, imagine that a child cannot be supported by the 
breast alone, and, therefore, ought to be allowed a more sub- 
stantial nutriment. Impressed with this erroneous notion, they 
provide the usual pap almost as soon as the child is born ; a 
species of food directly opposite to that which is appointed by 
nature, and derived from a healthy mother ; hence it cannot fail 
to prove injurious." 

250. "From this pernicious practice," continues the Dr., 
"arise inflations of the lower belly, gripes, and costiveness. — Such 
children become afflicted with insupportable pains in the bowels, 
the iliac passion, and subsequently with rickets ; they obviously 
lose strength, and muscular energy, notwithstanding all the care 
of plentiful feeding; their skin loosely covers their bones," &c. 
This is truly a hideous picture ; but is nevertheless true; yet, 
with this before him, he did not fail, two pages after, to recom- 
mend this very substance. 

1 Physical Education, &c. p. 224. "Ibid. p. 222. 



OF FEEDING THE CHILD IN THE MONTH, ETC. 81 

251. Every farinaceous substance, in a state of fluid mixture, 
is liable to become acid; or to ferment when heated, even by a 
lower temperature than that of the human body, if sufficiently 
long continued ; consequently, the child must experience all the 
evils which may follow such changes, when they take place in 
the stomach; therefore, all such substances must be highly im- 
proper. It may, however, be asked, will not the mixture just 
proposed be liable to the same objection? We say, No — at 
least, not to the same extent as the other; for if the milk be 
sweetened no more than to correspond in degree with the mother's 
milk; if it be sweetened with loaf-sugar, and given as soon as 
mixed, there will be very little disposition in it to change before 
the stomach will exert its influence upon it, and convert it into 
a new substance. 1 

252. To make, however, the mixture of milk, water, and sugar, 
always acceptable to the child's stomach, several highly impor- 
tant rules should be observed, and never departed from, when it 
is practicable to observe them. 

253. 1st, The milk should be pure; that is, not skimmed, nor 
previously reduced by water ; and should be used as quickly as 
possible, especially in warm weather, after it has been drawn 
from the cow. 

254. 2dly, When practicable, it should always be taken from 
the same cow. The reasons for this injunction are, -that cows, 
feeding upon the same materials, give different qualities of milk ; 
and the stomach becomes reconciled very often more readily to 
any one certain quality, than to a mixture. 

255. 3dly, The milk should be given as soon as possible after 
its mixture with the water and sugar, lest it should be disposed 
to ferment before it is exhibited. 

256. 4thly, It should never be mixed, but when wanted; and 
no more should be provided than the child will take in a short 
time, for it is much better to prepare fresh than to run the risk 
of its becoming sour before it is used. 

257. 5thly, The milk should never be heated by the fire; this 
should always be done by adding the water hot, that is intended 
for its reduction ; or by a sand bath ; this will give it a sufficient 

1 Dr. Cadogan says, " There are many faults in the quality of the food of chil- 
dren — it is not simple enough. Their paps, panadas, gruel, &c, are generally 
enriched with sugar, spice, and sometimes a drop of wine; none of which, they 
ought ever to taste." We perfectly agree that neither spices, nor wine, should 
enter into the composition of a child's food: but cannot consent that sugar should 
be omitted, since nature has largely furnished it in the mother's milk. — And we 
have ever found this article not only a useful, but a desirable addition to the food 
of a child. We sincerely believe that it does not happen once in a million of 
times, that sugar is not acceptable to children of all ages. It is proper it should 
be so, since it is highly nutritious. If sugar be improper, why does it so largeiv 
enter into the composition of the early food of all animals? It is in vain physi- 
cians declaim against this article, since it forms between seven and eight per cent, 
of the mother's milk. 



82 OF OBSERVANCES TOWARDS THE MOTHER 

temperature, without incurring the liability to be overheated by 
being placed on the fire. 

258. 6thly, In weather that is unfavourable for keeping milk, 
it should be placed in the coolest place that can be commanded; 
or kept in often-changed cold water. 

259. 7thly, Should the slightest tendency to acidity be ob- 
served in the milk, it should be rejected without hesitation ; nor 
should an attempt be made at its supposed restoration, by using 
an additional quantity of sugar, as this will eventually but in- 
crease the evil. 

260. We cannot declaim too loudly against the filthy, and 
oftentimes injurious practice of nurses, making every particle of 
the child's victuals pass through their own mouths. The only 
reason they can offer for this disgusting habit is to prevent its 
being given too warm — this, we grant, is a necessary and useful 
precaution, but it can be easily arrived at, without the aid of 
their lips, by adding hot water to the milk as just directed, in- 
stead of placing it over the fire. Or tasting it once will be every 
way sufficient — for if it is found too warm, it will be, by patiently 
waiting a few minutes, sufficiently reduced in temperature ; and 
it is better to take it rather cool than have it go through the 
nurse's mouth. In fact it is wrong ever to give the child victuals 
too warm. First, you run the risk of scalding its mouth, and 
secondly, it unnecessarily relaxes the stomach. An equally filthy 
practice to the one we have just reprobated is that of the nurse 
blowing on the food with her breath to reduce its temperature. 

261. Care should also be taken that too much food be not 
forced upon the child at once ; it is much better to feed it often, 
than that it should receive too much at a time; for the child, 
when it is fed, cannot exercise the discretion it is wont to do 
when it sucks ; for when it has received enough by its own exer- 
tions, it will stop spontaneously. 



CHAPTER XV. 

OP OBSERVANCES TOWARDS THE MOTHER DURING THE MONTH, AC. 

262. If the directions already given for the general conduct 
of the woman during labour, and immediately after her delivery, 
be strictly observed, it will rarely happen that she will not have 
what is called "a good getting up." This good getting up con- 
sists in the gradual restoration of health, by a return of strength, 
through the proper exercise of the functions of the stomach, and 
the judicious employment of the various muscles of the body. 



DURING THE MONTH, ETC. 83 

263. To insure the healthy play of the stomach, and of the 
muscular system in general, the patient should be managed in 
such a manner as will, in great probability, prevent the occur- 
rence of disease, rather than be treated as if the evil were abso- 
lutely present. For this purpose, frequent changes of linen, and 
of every other solid article, is absolutely necessary, that there 
may be no offensive gases generated, to contaminate the air of 
the room, and render it unfit for the purposes of respiration. 

264. Fresh air should, therefore, be freely admitted into the 
room ; but the woman should be placed so as not to receive a 
partial current of it. Unfortunately for the interest of the pa- 
tient, the nurse thinks for her on the subject, and effectually to 
guard against the possibility of such an accident, she encloses 
her in a space of six feet square, by curtains, and condemns her 
to the horrors and mischiefs of breathing twenty times the air 
that has already been as often discharged from her lungs, and 
each time loaded with an increased quantity of irrespirable gases. 

265. One of the greatest improvements the lying-in room could 
receive, would be, to banish curtains from the list of the " indis- 
pensables," for furnishing it, or, at least, so to manage them as 
to make them subservient to ornament alone. The pretexts for 
the employment of curtains are, first, " the bed looks so naked 
without them;" — this requires but a few fashionable examples, 
to make it appear "when unadorned, adorned the most;" and it 
were a "consummation devoutly to be wished," that some few of 
influence would lend their aid for this purpose, for the benefit of 
their fellow-creatures. Secondly, " the danger of catching cold;" 
— this is sheer cant; let every patient commence without these 
articles, as many from necessity are obliged to do, and they, like 
them, will have nothing to complain of that should be directly, 
or, with propriety, charged to the want of curtains. If a room 
be so situated as unavoidably to expose the woman to a draught 
of air, a temporary screen will fulfil every duty the curtains 
possibly can, without involving her in any risk. Thirdly, "to 
protect the woman against too much light." This reason is even 
more futile than the one last noticed; for the inlets by which 
light is admitted can readily be shut, without expense, or any 
very great exercise of genius. Fourthly, and lastly, " Curtains 
in cold weather are necessary to keep the patient warm." An 
additional blanket will do this vastly better. 

266. Fresh air, we must repeat, is of the greatest possible 
service to the lying-in woman ; it is, in a word, indispensable to 
the regular return of health ; and, if properly indulged in, will 
prepare the patient, without hazard, for the enjoyment of it abroad, 
in suitable weather. It has been put to us as a question, "How 
soon can a woman after confinement venture abroad safely?" 
This question, like many others, would seem to require no con- 



84 OF OBSERVANCES TOWARDS THE MOTHER 

dition, and might be directly replied to : but it, like many others 
of the same apparent simplicity, involves a number of considera- 
tions, which are essential to be known, before it can be properly 
and satisfactorily answered. 

267. 1st, Because the period which may have elapsed after 
delivery, cannot, of itself, be a guide ; for some women are 
better at the end of five days than others may be at as many 
weeks; therefore, the actual condition of the woman must alone 
be considered, and this without reference to the days that may 
have elapsed from the birth of her child. 

268. 2dly, Because the season of the year, and state of the 
weather, will very much influence a decision of this kind; for the 
weather may be such for weeks together, as to render it improper 
for a delicate woman to leave the house; as, in winter, fall, or 
spring, or even in summer, it might, for a short time, be equally 
so from heat or rain. 

269. Therefore, a conditional answer must always be given 
to this question ; and, we would say as a general rule, if, at the 
middle or end of the third week after confinement, the weather 
be fine and sufficiently warm to render much additional clothing 
unnecessary; and, if the patient be without disease, though, 
perhaps feeble, she may venture abroad in a close carriage, with 
much advantage to herself and child. Robust women, when free 
from any febrile affection, or local inflammation, may venture 
even earlier. And, it may be well to recollect, that the sooner 
the patient can take the fresh air the better ; since both she and 
the child will profit by its influence ; — for there is a vigour and 
a healthy play given to every function of the body, by air and 
exercise, that cannot be procured by any other means. The 
best nurses are, therefore, those of active habits, and those 
who can give employment to all the muscles of the body in the 
open air: for, it will be obvious to every one, that, if the func- 
tions of the body be not healthily performed, especially those of 
the circulation and the various secretions, the products of their 
actions cannot be entirely healthy; therefore, the milk by which 
the child is to be sustained may not be sufficiently nutritive, or 
fail in other highly important qualities. 

270. To a nurse as well as to her child, there can be nothing 
more prejudicial than an indulgence in habits too sedentary: 
the exercise, therefore, we have recommended, should be enjoyed 
whenever fit occasions may present themselves, that the milk 
may be more certainly and abundantly secreted, and, at the 
same time, its invigorating properties be increased; but, in in- 
dulging in exercise, it is always to be understood that any excess 
of it will be prejudicial. We would, therefore, wish to be con- 
sidered to mean only that degree of it which shall not too much 
hurry and disturb the circulation, or occasion the woman to be 



DURING THE MONTH, ETC. 85 

over-heated — consequently, running, too fast walking, or dancing, 
should be carefully avoided; especially as much injury is done 
the child by its receiving the milk, after such violence has been 
offered the circulatory system. 

271. But should accident, necessity, or inattention, place the 
system in the situation just mentioned, the child must be with- 
held from the breast for at least two hours after the occurrence ; 
and then the milk which was present in the breast at that time 
must not be offered it — it must be drawn off by some other means 
and thrown away. The same may be said after an indulgence 
in any violent passion or emotion of the mind, as the most fright- 
ful and deadly consequences have followed a neglect of this pre- 
caution. 

272. It is said by many to be a good practice, "to gradually 
accustom the woman to the air in the house, before she ventures 
abroad;" and too many adopt the plan, to the serious injury of 
the patient. This is done in cold weather, by making her travel 
up stairs 1 and down in a strong current of air. The consequences 
of such exposure may be easily imagined. 

It would be very proper for the woman to pay strict attention 
to local cleanliness, which is best managed by washing the parts 
once or twice a day with lukewarm water. A neglect of this 
ablution will be severely felt by the patient, as well as every 
visiter to her chamber. Let her not be deterred from this ne- 
cessary and cleanly duty, by the opinions or the threatenings of 
any gossip that may chance to visit her — her strength will be 
certainly improved, her appetite amended, and her milk will be 
more abundant, and of better quality. Her infant will, therefore, 
partake of the general benefit. This is well worthy of the at- 
tention of every woman, for it will materially aid in preventing 
that hateful discharge, leueorrhoea. 

' There is a custom, among nurses and gossips, no less absurd than ancient, 
which obliges the woman to go "up stairs" before she ventures down; and this 
is insisted on, be the season or weather what it may. By this plan, the woman 
may be exposed to a cold and chilling atmosphere, immediately after leaving a 
warm room, and, sometimes, perhaps, even when she is in a state of perspiration. 
We have known a number of instances of severe " pull back," as they are called, 
produced by a compliance with this superstitious and dangerous practice. The 
good sense of every woman, who may become the object of this improper custom, 
should be exerted to destroy it, by not complying with it — and this at the risk 
of even offending " a nurse." 



86 OF THE DUTIES OF THE MOTHER 



CHAPTER XVI. 

OF THE DUTIES OF THE MOTHER AFTER THE MONTH, ETC. 

273. There is no solicitude more natural, nor more painful, 
than that which a young and inexperienced mother feels, -when, 
for the first time, she is left to her own guidance in the manage- 
ment of herself and child, by the departure of her nurse. Tor, 
up to this moment, she looked to her for every direction, and for 
the fulfilment of every necessary and important office, as well 
for herself as for her child. But, left to her own discretion, she 
feels, with more than necessary force, perhaps, the responsibility 
of a mother — of a mother, on whose care and judgment the fu- 
ture health and welfare of her child depend. She is willing to 
suffer privations, or even to make sacrifices for its benefit, but is 
ignorant when the one might be necessary or where the other might 
be availing. Uncertain, from want of experience, of the pro- 
priety of any thing she may do for either its comfort or its use, 
she trembles, lest she commit an error; nor is she confirmed in 
her own opinion until she has the cold and negative proof that 
what she has done has not done harm. Or she may, from too 
great an indulgence of her fears, neglect the most common and 
obvious of her duties. 

274. The delightful task, to the inexperienced mother, of 
washing and dressing her infant, is to her a source of inexpres- 
sible anxiety. She applies water to its body with a sparing and 
trembling hand; 1 the child, perhaps, cries upon its application; 
the over-sensitive mother becomes alarmed, lest she has given it 
unnecessary pain, or has done something improper; she becomes 
agitated, and but partially washes, and but imperfectly dries it; 
or she abandons the operation to one of less feeling, but, per- 
haps, of no more experience than herself, and this, perhaps, to 
the injury of the child. 

275. We once witnessed a most interesting scene between a 
young mother and her husband, upon an occasion similar to the 
one of which we are now speaking. We were chatting with a 
young lady in a lively manner, when her husband suddenly en- 
tered the room — she sprang upon her feet and violently clasped 
him round the neck, and with a convulsive cry of exquisite plea- 
sure she sobbed out, "I dressed our Julia to-day, entirely with 
my own hands!" And never did we see a finer subject for a 

1 We have elsewhere observed the water should never be cold that is applied 
to the child's body, but lukewarm, for whenever it produces a shock it does 
mischief. 



AFTER THE MONTH. 87 

skilful painter, than the one presented by this interesting couple, 
at this moment. We soon learned that the performance of this 
duty had, up to that moment, been one of great misery to the 
too timid mother. 

276. We would recommend to every mother with her first 
child, to try her skill daily at washing and dressing her infant, 
a week or ten days before her nurse leaves her, that she may 
become familiar with the routine, and gain a little experience in 
the method. Indeed this cannot be too seriously recommended ; 
the mere handling of the child requires, to do it in the best man- 
ner, some experience; a mother may learn much as respects this 
from a handy and experienced nurse, and will be amply repaid 
for looking on during the operation. 

277. The next anxiety which a young mother feels, is upon 
the subject of what is most proper for her to eat and drink, "as 
a nurse." For this information, she appeals to those whose 
greater experience, she supposes, would well qualify them to 
answer. By one, certain articles of diet are recommended as 
indispensable; by another, they are condemned as improper, 
if not as positively injurious. Other substances are extolled in 
their turn ; but, unfortunately, these are forbidden by other ad- 
visers, and that with an earnestness that bids defiance to either 
argument or resistance. Perplexed by such discrepancies, she 
knows not what plan to pursue; and when she has become al- 
most a prey to anxiety, some sensible friend lays down a rule, 
which, as a general one, is the only one which should have been 
given at first ; namely, to eat and drink such articles of diet as 
her former experience had proved did not disagree with her own 
stomach, and to pursue this plan, unless a farther experience 
should declare it to be injurious to herself or her child. 

278. No advice, perhaps, can be more safe and judicious than 
this ; for we have almost uniformly observed, that whatever food 
is found to agree with the mother, is almost sure to do so with 
the child ; therefore, such substances as are said to disturb the 
latter, will almost always be such as have disagreed with the 
mother previously. Nor is this of difficult explanation. Any 
substance, with which the stomach is not familiar, or to which 
it is not entirely reconciled, will be either rejected altogether, 
or will be but incompletely digested. . If it be but imperfectly 
assimilated, it will enter the system as ill-elaborated chyle ; and 
this, necessarily, will make a corresponding change in the quality 
of the milk. In this state it is received by the child; its stomach 
not being able to subdue it to a proper nourishment, flatulency 
is produced, or, perhaps, even vomiting ensues. 

279. Certain liquors, as ale, porter, beer, &c. ; certain sub- 
stances, as cabbage, sweet potato, pickles, vinegar, &c, are all, 
in their turn, said to disagree with the child — that is, as we 



88 OF THE DUTIES OF THE MOTHER 

would insist, they disagree with the mother ; they should, there- 
fore, be abandoned, without hesitation, for her own sake — for 
there the mischief begins; but there it will not stop, unless she 
have sufficient resolution to give them up ; for her child will soon 
feel the effects of such irresolution; and how extensive these 
may become it is impossible to say. 

280. Serious mischief is oftentimes done by the mother at- 
tempting to remedy every temporary diminution of milk, by in- 
creasing the quantity of her food, or by imagining that some 
stimulating drink will answer this valuable end. Hence, indi- 
gestion, fever, and sometimes a habit is generated of too freely 
indulging in ardent spirit. This practice has, for its excuse, that 
the milk fails because the woman is weak, owing to her not 
taking a sufficiency of nourishment; hence, too much feeding is 
indulged in, to remedy this supposed weakness — a task is now im- 
posed upon the stomach that it cannot perform, however healthy 
it may be, and indigestion must, of course, sooner or later, be the 
consequence. Or, owing to some trifling disturbance in the sys- 
tem of a temporary kind, the secretion of milk may be for the 
moment suspended or diminished: an attempt is made to recall 
it by an increase of food, by which a slight inconvenience is con- 
verted into a permanent derangement of the system ; or a fever 
of even a dangerous character may be generated. Or, owing to 
a false theory, or imperfect observation, it has been supposed 
that certain liquors have a control over the secretion of milk ; 
and hence, the too free use of certain combinations, in which 
ardent, or fermented spirits, too largely enter: thus, porter, ale, 
milk punch, &c, become the ordinary beverage of nurses, to the 
almost certain destruction of their morals. 

281. We must not, however, be supposed to deny the influence 
of certain solid as well as fluid substances, upon the secretion 
of milk: this would be turning our eyes from reason, as well as 
experience ; for we well know, that unless the body be properly 
supported, there must soon be a diminution of milk. We only 
mean to insist, that it is the nutritious, and not the stimulating 
part of diet, that is subservient to the plentiful and healthful 
formation of this fluid. In proof of this, we need only observe, 
that we have often been consulted upon the subject of the failure 
of milk, where an anxious mother herself, or a hireling nurse 
was concerned, and been informed by them, that they had tried 
every thing with a hope of improving it ; such as rich victuals, 
porter, ale, beer, milk punch, &c, without success, or it was fol- 
lowed, perhaps, by a diminution of it. 

282. In such cases, we have often succeeded in producing a 
plentiful supply of milk, by adopting the opposite plan of treat- 
ment ; for it must be borne in mind, as an important truth, that 
this failure proceeds more frequently from an over, than from an 



AFTER THE MONTH, ETC. 89 

under quantity of food, or of drink. It is a fact, well known to 
all who have paid attention to the consequences of arterial ex- 
citement, that when it amounts to even moderate fever, the milk 
almost immediately diminishes in quantity; and, also, when this 
action is diminished, (provided it had not continued too long,) 
by suitable remedies, that the secretion of milk again becomes 
more abundant. 

283. Upon this principle, we have frequently prescribed evacu- 
ants, and abstinence, to promote the secretion of milk. With a 
view to illustrate this situation of the breasts, under an increased 
excitement of the system; and the advantage, nay, the absolute 
necessity of reducing the force of the blood vessels, for the pur- 
pose of restoring their secretory functions, we will relate one, of 
several cases, in which this plan was pursued. 

284. Mrs. informed us, with great concern, that she would 

be under the necessity of procuring another wet nurse for her 
child, as the milk of the one she had diminished so rapidly as 
to make her certain her child could not be half nourished. It had 
begun to fail about three weeks before, without any evident 
cause ; and although she had constantly tried the most generous 
diet and cordial drinks she could hear of, still it diminished daily, 
and was now so reduced, as to scarcely offer enough for the child, 
once in twenty-four hours; or, rather, the whole quantity fur- 
nished in that period would not amount to more than one good 
meal. 

285. We requested to see the nurse; she was, accordingly, 
presented. She was a young, healthy-looking woman of florid 
complexion, and clear skin, and without a single mark that 
would lead to the suspicion of a deficiency of milk from any 
imperfection of constitution — her milk was six months old, as it 
is called; she had been engaged in this family about three of 
that time. She was from the country, and for some time gave 
entire satisfaction, as to her conduct, temper, health, and quan- 
tity of milk. Upon being questioned, we found that she was 
living upon a much more generous and stimulating diet than 
she had been previously accustomed to — she not only ate more 
at each meal than she had formerly done, but ate a greater 
number of meals ; and, instead of drinking milk, water, or milk 
and water, as she was wont to do before at such times, she was 
indulged in porter, ale, beer, milk punch, &c, with a view of 
keeping up her milk. 

286. We found she had occasional headache; rested ill at 
night ; had a disagreeable taste in her mouth in the morning ; 
her tongue was furred, and her pulse full and frequent. It was 
evident her system was too much excited by her mode of life, 
and that nothing would restore her milk but a reduction of diet. 
We accordingly ordered her to be bled; to take a brisk dose of 



90 OF THE DUTIES OF THE MOTHER, ETC. 

salts ; confine herself to a strict vegetable and milk diet, and to 
drink nothing but water. 

287. At first we experienced much opposition to this plan ; 
but it was eventually submitted to, and with such complete and 
rapid success, that in a week there was a sufficient secretion of 
milk. It may be proper to observe, that this woman, after this 
period, confined herself to a plain, simple diet, and never after 
had occasion to complain of a deficiency of milk. 

288. This case, among many others, shows us, that the scheme 
the wealthy and plentiful families adopt with their wet nurses, 
is wrong from beginning to end. As little change should be 
made in the diet of the nurse as is strictly consistent with suffi- 
cient nourishment, and none, perhaps, in her habits of employ- 
ment ; that is, she should not exchange active for passive habits. 
If she have been accustomed to work, give her, by all means, 
uniform employment. If she have been much exposed to the 
air and weather, let her and the child have the advantage of air 
and exercise, upon all proper occasions. The extremes of heat 
and cold should, of course, be avoided, as well as a wet atmo- 
sphere. 

289. This case, also, well illustrates the position we have 
endeavoured to sustain ; namely, that a stimulating diet is not 
the best method to procure an increase of milk. But, at the 
same time, we are far from declaring that a more generous diet 
may not be occasionally necessary; — but such cases are by no 
means so common as is generally imagined, and still more rarely 
is a stimulating one proper. 

290. The remedies which we have ever found to contribute 
most to the improvement of the milk, are, regular exercise in 
the open air, milk and water, milk alone, malt tea, 1 molasses 
posset, 2 or porter, or ale posset, 3 when a mild stimulant may be 
required. These may be drank freely, at any period of the day 
or night; and the nurse who may employ them will find herself 
much satisfied with their eifects. 

291. Having, in the foregoing pages, considered what may be 

1 Malt tea is made by pouring a quart of boiling water upon a gill and a half 
of ground malt, which is permitted to stand, after two or three good stirrings 
with a spoon, until cold: it must then be strained off. The tea may be sweet- 
ened, or not; or it may have the addition of milk. 

3 Molasses posset is made by throwing a wineglass full of molasses into a 
quart of milk, after the latter has been heated nearly to the boiling point ; it is 
then permitted to cool — the whey to be poured off and drank. 

3 Porter or ale posset is made precisely as directed for the molasses posset, 
except that half a pint of either of these liquors is substituted for the molasses, 
and it is permitted to stand until a separation takes place. 

Dr. Struve says, (Phys. Ed. p. 225,) "There are certain means by which the 
milk of a suckling woman may be increased or diluted. In the first place, I 
would advise her to drink a glass of cold water every morning, but to adopt no 
remedies, however specially recommended by common midwives." He then 
recommends the porter posset suggested above. 



RECAPITULATION. 91 

proper for the woman during the period of gestation, labour, 
and during the period of confinement; also, what may be deemed 
important to the child after its birth to the end of the month, 
it may be farther useful to bring the whole of our instructions 
upon these points into a condensed form: we shall, therefore, 
sum up the various directions we have given, divested of the argu- 
ments by which they were sustained, in the form of a " Recapi- 
tulation." By this means, the reader can in a moment become 
possessed of the instructions, without going through, a second 
time, the reasonings. This plan will contribute to aid the me- 
mory much, since the directions are numerous, and, perhaps, in 
some instances, novel ; and may require repetition, to fix them 
sufficiently well upon the recollection of those who may wish to 
abide by them themselves, or merely to inform themselves what 
can be said upon this interesting and highly important subject. 



CHAPTER XVII. 

RECAPITULATION OF THE INSTRUCTIONS GIVEN TO THE FEMALE 
DURING PREGNANCY, LABOUR, AND CONFINEMENT ; AS WELL AS 
RULES FOR THE GENERAL MANAGEMENT OF THE CHILD DURING 
THE MONTH. 1 

292. To prevent abortion, &c, she should scrupulously observe 
the following rules : — 

293. 1. She must avoid all unnecessary and, especially, vio- 
lent exercise, or exertion; such as too fast walking, running, 
dancing, &c. 

294. 2. To avoid, as much as may be, placing herself in a 
situation which may subject her to unpleasant sights or seeming 
dangers. 

295. 3. To shun overheated rooms, and stimulating liquors 
of every kind. 

296. 4. To avoid all substances that have a tendency to pro- 
duce a costive state of bowels ; or those which may give rise to 
"indigestion," as late suppers, too great a quantity of food, 
&c, &c. 

297. 5. To take no substance, or drug, that shall give too 
frequent and too severe motion to the bowels ; or such as shall 
too severely constipate them, as chalk, opium, &c. ; and, espe- 

We have not thought it necessary to make a summary of the chapter upon 
" Marriage. " 



92 RECAPITULATION. 

cially not to disregard the calls of nature, when they would be 
successfully exerted. 

298. 6. To remove from her chest, waist, and abdomen every 
restraint; lest undue pressure should be made upon them. 

299. 7. To avoid all substances that may have a tendency to 
increase the irritability of the system; as strong tea, coffee, 
opium, &c, the too long indulgence in bed, &c. 

300. 8. To shun all severe study, night watching, &c. 

301. 9. To avoid, with much care, unnecessary blood-letting, 
or submitting to this operation, merely because she is pregnant. 

302. 10. To have, however, recourse to this operation, when 
pain, headache, a sense of fulness, giddiness, the loss of, or im- 
perfect sight, &c. may be present to declare the necessity of it 
— but it were always better, when practicable, to have the advice 
of a physician. 

303. 11. The woman who may be in the habit of miscarrying, 
should never venture upon blood-letting without advice, as it 
sometimes produces the evils it is intended to prevent. 

304. 12. To avoid the indulgence of all inordinate appetites; 
as too much repletion of the stomach may give rise to many 
formidable diseases. 

305. 13. She must give up the false notion, that more food, 
&c, than ordinary, is required because she is pregnant, as the 
opinion is not founded in either reason or experience. 

306. 14. She must assure herself, by a reliance upon the 
opinions of those whose business it is to ascertain the truth upon 
this point, that nature institutes the sensation of nausea, and 
the act of vomiting, with a view to prevent too great fulness 
during this period. 

307. 15. She must not indulge in the fear that should a 
certain longing have been ungratified, her child incurs the risk 
of being marked in consequence of the disappointment, as this 
apprehension is not warranted by reason, nor confirmed by ex- 
perience. 

308. 16. She must dismiss from her mind all apprehension of 
future consequences to her child, should she have been so unfor- 
tunate as to have suffered any great alarm ; been surprised by 
any unexpected event, or appalled by some frightful object or 
occurrence — as there is no one good reason to believe in such 
influence upon the child. 

309. 17. To most sedulously guard against any sudden gusts 
of passion; as any indulgence in them may be highly injurious, 
if not fatal to herself and child. 

310. 18. To solicit, as much as possible, tranquillity, and 
equanimity ; as their influence is highly valuable to herself and 
child. 

311. 19. To believe, in general, that food injures more by its 



RECAPITULATION. \)6 

excess, than its quality ; by taxing the powers of the stomach 
too highly. 

312. 20. To avoid, with as much care as she would impending 
ruin, an indulgence in cordials, liquors, &c, under the pretexts 
of calming sickness, relieving pain, or expelling wind; as a 
destructive habit is but too easily generated by their employ- 
ment. 

313. 21. She must not persuade herself it is only the exces- 
sive indulgence in such articles, that is mischievous ; but she 
must clearly understand that every thing which may unduly sti- 
mulate the system, is highly injurious to the pregnant woman. 

314. 22. Let her turn a deaf ear to every tale of disaster, 
or of horror, which purports to have happened to the pregnant, 
or lying-in woman ; for, upon investigation, such tales will al- 
most always be found without foundation, or very greatly exag- 
gerated. 

315. 23. Let her procure the best aid, for the period of her 
necessities, that circumstances will permit. 

316. 24. Let her not be imposed upon by a false theory, or 
bad advice ; nor use too much exercise towards the latter period 
of time, lest she provoke premature labour. 

317. 25. Let her not, when the period of labour is approach- 
ing, indulge in gloomy forebodings, or unreasonable fears for 
the event ; nor, by any means whatever, forget how rarely death 
happens during, or even after, a well-conducted labour. 

318. 26. Let her not attempt to increase the frequency or 
force of her pains, by taking improper articles of food, or by 
frequent marchings across the floor, 

319. 27. Let every precaution be taken against an attack of 
fever : for this purpose she must scrupulously avoid every stimu- 
lating substance, either as food, drink, or remedy. Let her bear 
in mind that an overcharged stomach is always unfavourable to 
the healthy progress of labour, or its eventual safety. 

320. 28. To prevent despondency because the labour may be 
rather longer than she anticipated, let her recollect that the 
safety of this process does not depend upon the celerity with 
which it is performed. 

321. 29. That she may secure to herself the best possible 
chance for her safety, let her have no opinions of her own, that 
may clash with those of her medical attendant ; let her, therefore, 
be passive and obedient. 

322. 30. Let her not, as she values her life, indulge in any 
gust of passion ; lest she provoke incurable convulsions. 

323. 31. Immediately after she is a mother she must impose 
upon herself the most perfect tranquillity; that no untoward 
circumstance may be provoked. 

324. 32. She must carefully avoid all the exciting causes of 



94 RECAPITULATION. 

fever, as far as in her power, by not indulging in improper 
articles of diet; sitting up too early, and too long; too hot a 
room; curtains too much closed; or seeing too much company. 

325. 33. She must aid the exertions of her physician to pre- 
vent any after evil, by implicitly following his directions, and 
preventing, as much as may be in her power, the nurse running 
counter to them, especially until after the fifth day is complete. 

326. 34. Let her not permit herself to be persuaded from 
having her child put to the breast, as soon as she herself may 
be able to bear the fatigue. 

327. 35. Let her not delegate to another the sacred duty of 
nursing her own child; unless the reasons for so doing be insur- 
mountable. 

328. 36. She must most scrupulously attend to the dressing 
and undressing, or even performing this herself, when her health 
and strength will permit this delightful task. 

329. 37. She should never, under any pretext of convenience, 
permit her child to be fed, so long as she can supply it with 
sufficient nourishment herself, and to secure to herself this im- 
portant point, she should pay a scrupulous regard to her diet, 
and her exercise in the open air. 

330. 38. The dressing of the child should early engage the 
attention of the mother; it should always be made subservient to 
comfort, instead of show. 

331. 39. This should consist in part of flannel; especially 
during cold or even cool weather. 

332. 40. The dressings of the child should be changed as 
often as they become soiled, when this luxury can be indulged 
in. 

333. 41. Though it may be found that flannel is the most 
eligible substance, as a general rule, there are cases in which it 
may be improper ; and these should be carefully distinguished. 

334. 42. The belly band is one of the most important parts 
of the child's dress; it should always be made of flannel, and 
should be always cut bias. 

335. 43. The greatest care should be taken to apply it pro- 
perly; but too tight an application should be carefully avoided. 

336. 44. If this bandage be applied too tightly, it may pro- 
duce the evil it is intended to prevent. 

337. 45. The child should be carefully protected against all 
unnecessary wet; and when it is discovered to be in this situa- 
tion, it should be changed as quickly as possible. 

338. 46. In dressing the child, as few pins should be employed 
as possible ; three are all that are necessary, if the clothes be pro- 
perly arranged. 

339. 47. As a general rule, the child should never be fed, at 
this period of its life; there may be exceptions, however, that 
may render this necessary. 



OF THE NURSERY. 95 

340. 48. When an exception to this rule exists, the food of 
the child should consist of milk, water, and sugar; and exhibited 
under the important restrictions we have made. 

341. 49. If the child be fed, it should have but small quantities 
at a time, and never crammed to surfeit. 

342. 50. The woman should exercise in the open air, as soon 
as this is rendered safe, by the state of her health, the period 
after confinement, and the state of the weather. 

343. 51. She should never subject herself to partial expo- 
sures under the hope of " hardening herself." 

344. 52. The reapplication of a diaper after it has been dried 
simply, should be prohibited; as several evils arise from the 
practice. 

345. 53. The mother may indulge in such diet as her experi- 
ence has proved to be innocent — for it will seldom or never dis- 
agree with the child, when it perfectly suits the mother. 

346. 54. When the mother experiences any inconvenience from 
the use of any substance or substances, she should not hesitate 
a moment to abandon them ; for if they disagree with her they 
will be sure to do so with the child. 

347. 55. Should there be a failure in the quantity of milk, 
the mother must not attempt to increase it by highly seasoned 
food and stimulating drinks. 

348. 56. She may sometimes, however, use, with great advan- 
tage, the nutritious substances recommended in the text. 

349. Having, in the preceding pages, considered the duties 
of the mother during pregnancy, and confinement, we shall 
now proceed to detail what may be proper for the offspring, from 
the period of its birth to that of puberty. We shall confine 
ourselves, in this part of our subject, strictly to the physical 
influence of certain agents upon the human body; and the most 
proper physical education, up to the period just prescribed. The 
medical treatment will form a distinct subject of consideration, 
and the moral we do not propose to treat of. But, before we 
commence this part of our subject, it will be well to describe the 
requisites of a nursery. 



CHAPTER XVI1L 



OF THE NURSERY. 



350. Every body, almost, in easy circumstances, has a part 
of the house appropriated to what is called the "Nursery." 
The one chosen for this important purpose is, generally, or at 



06 OF THE NURSERY. 

least too often, the most exceptionable part of the building. It 
is usually selected because it is "handy," or because it is the 
only one that can be spared ; without the smallest attention be- 
ing paid to its fitness for the purpose for which its designed. 

351. The room for the purpose of a nursery should have every 
advantage which space or location can give, when either or both 
can be commanded. We shall, therefore, say in what a well ap- 
pointed nursery should consist, leaving it, of course, to the abi- 
lity of every individual to adopt or approach it, as nearly as 
circumstances may permit. 

352. The nursery should be spacious, with a high ceiling, and 
perfectly dry; it should not be exposed to the operation of any 
cause that may render it damp; as, on aground-floor; too much 
shaded by trees, or placed beyond the occasional influence of the 
sun. Its windows should be tight, and the walls dry; the floor 
should be of wood that will quickly dry after being wetted for 
the purpose of cleanliness ; but the utmost care should be taken, 
not to hasten this process, by placing ignited charcoal in its cen- 
tre. Serious mischief has frequently arisen by this absurd and 
dangerous practice. 

353. It should be so situated, that the door or doors shall not 
open immediately on staircases ; or, should this be unavoidable, 
the heads of the stairs should be secured by latticed half-doors, 
and these so constructed, by having their slats placed perpendicu- 
larly, that the child cannot climb upon them, and thus defeat 
their object. 

354. The windows should have cross-bars placed before them, 
to remove apprehension of accident to the child. They should 
be five inches distant from each other, that the windows may be 
opened for the purposes of ventilation or air. They should have 
shutters, that the room may be darkened, when the abstraction 
of light becomes necessary. The windows should not have cur- 
tains of a glaring colour, as the light will be increased thereby, 
and prove injurious to the eyes of young children. 

355. If possible, the nursery should consist of two rooms; and 
if they opened into each other, it would yield very great advan- 
tages ; the children could retire to one, while the other was ven- 
tilating, or getting cleansed, by washing or sweeping; this would 
contribute greatly to their comfort, as well as to their health. 
They would, also, be removed from the dangers of damp, the 
inconvenience of dust, the risks from a cold stream of air, while 
the room is drying or sweeping, besides having an enlarged space 
for the exercise of their limbs. In a space so extensive as this, 
they could improve their strength by engaging in many little 
sports, which children are so ingenious in devising, when they 
cannot, from the condition of the weather, take exercise in the 
open air. 



OF THE NURSERY. 97 

356. Besides, such an arrangement will permit the children to 
have a room, fresh and sweet, in the morning, after having ren- 
dered the other foul by sleeping in it. This is an advantage 
■which has been but too little attended to, notwithstanding its 
obvious utility ; especially to the younger children, who cannot 
always escape into the purer air of other parts of the house. 

357. Carpets, in cold weather, are decidedly useful, if they 
be properly managed ; that is, well shaken and aired, every week. 
By this means the dust is removed from them, and they have 
the advantage of becoming dry by exposure. We are sensible 
that several objections may be raised against carpeting a nursery ; 
as the great quantity of dust they accumulate; their becoming 
often wet, without the chance of drying; their retaining grease 
so fixedly as not to be removed; their absorbing, and then giving 
out a variety of impurities, &c. But, notwithstanding all these 
reasonable objections, we are persuaded, that one single advan- 
tage which they possess in a nursery overbalances all that may 
be said against them — namely, their protecting the heads and 
limbs of children from injury when they fall. 

358. The elastic material (wool) of which the carpet is formed 
is well calculated to break the force of the blow which the head 
or limbs of the child receive, when it falls upon it; so much so 
is this the case, that we have not known a single instance of se- 
rious injury from falls upon them. We are sure to have our 
anxiety diminished, when called to a child who has received a 
blow upon the head from a fall, when we are informed it fell 
upon a carpet. We are, therefore, of opinion, that when the 
child falls from a moderate height, it will rarely, if ever, suffer 
a serious injury from it — this, certainly, would not be the case, 
did the child fall upon the naked floor. 

359. We must, however, be understood to recommend carpets 
in cold weather only ; for as soon as the weather becomes suffi- 
ciently warm to do without fire, the carpet should be removed^ 
and its place supplied by an even, well-stretched mat; or the 
floor may even be left bare ; for at this period, it is to be pre- 
sumed, children will be but little confined to the nursery, unless 
the state of the weather prohibit their enjoying the open air: 
this state of the weather may consist in its being wet, too windy, 
or too hot. 

360. The furniture of a nursery should be as little in quantity 
as convenience will permit, that the children may have the space 
that would be necessarily occupied by many articles; especially 
chairs and tables. It should, therefore, consist of the beds for 
the children and nurse, or we would rather say mattresses, as w r e 
are of opinion that feather beds should be driven from the nur- 
sery, for the following reasons — first, they are too warm for the 
purposes of the best health, especially with feeble children; ac* 

7 



98 OF THE NURSERY. 

cumulating so much heat as to unduly stimulate the whole cuti- 
cular system ; thus giving rise to unnecessary, nay, injurious 
perspiration; secondly, the effluvium from feathers is extremely 
oppressive, particularly in warm weather, and to children of fee- 
hie lungs ; thirdly, they discharge a prodigious quantity of dust, 
intermixed with minute portions of down, occasioning cough and 
other inconveniences. 

361. If it be objected, that mattresses are too cold in our cli- 
mate for winter, we would immediately obviate it, by recommend- 
ing the spreading of a blanket over the mattress, which will 
effectually remove the inconvenience complained of. 

362. When practicable, children should sleep in separate beds ; 
and these should be large; for it is injurious to have them 
cramped when they sleep, as well as indelicate to crowd opposite 
sexes together. Besides, the degree of heat generated by contact 
will be certain to make them uncomfortable; they will throw off 
the bed-clothes, and thus expose each other to colds. 

563. Children should never have more bed-clothes spread over 
them than is sufficient to maintain a proper degree of warmth; if 
more be put upon them, they become oppressed, or perspire; 
both of which should be avoided : or they become too warm, and 
throw the bed-clothes off them, and thus when the skin is pouring 
out perspiration, the discharge is suddenly checked, to the mani- 
fest injury of the child. We have often known whole nights 
spent without covering; for if children become cold from re- 
moving the clothes, they are very rarely sensible of it ; they 
sleep too soundly, for the most part, to restore the covering 
again, 

364. Should we not, however, succeed in establishing our ob- 
jections against feather beds in winter, we are persuaded every 
body will agree in the use of mattresses during hot weather. 
Should these not be at command, the sacking bottom, or even 
the floor, should be substituted — for almost any thing is prefera- 
ble to feathers, 

-365. It is in the nursery, in a great measure, that the habit 
of early or late rising is generated — this is a matter of much 
importance; and the greatest regularity should be observed, that 
a proper one be formed. Children should, therefore, retire at a 
regular, and sufficiently early hour, to insure their early getting 
up; for beyond a certain time sleep is injurious. It would, 
however, be a little difficult to establish a positive rule upon this 
subject, as some children, like adults, will require more sleep 
than others. Children who exercise much will need more sleep 
than those who exercise but little; consequently they should not 
be confined to precisely the same number of hours. 

366. All children are disposed to be early risers; this pro- 
pensity should, therefore, be cultivated by permitting them to 



OF THE NURSERY. 99 

retire sufficiently early to bed; and after they are in bed, they 
should not be allowed to keep each other awake by playing, and 
thus depriving themselves of sleep : for the same reason, no noisy 
employment should be permitted in the nursery, that the children 
need not be disturbed. Indeed, it would be best, when children 
have attained their third year, or even before, that they should 
not be allowed even light in their rooms, that they need not un- 
necessarily be kept from sleep, as well as to prevent any appre- 
hension from being left in the dark. 

367. When children first awake in the morning, however early 
this may be, provided it be day-light, they should be allowed to 
get up, and be dressed; for if this be not done, and they are 
forced to lie longer than is pleasant to themselves, they will be- 
come fretful and dissatisfied, or again fall to sleep — in either 
case, a real evil is induced : in the first, the disposition of the 
child is injured; and, in the second, a, habit of lying too long 
is generated, 

368. It should be carefully guarded against, that no unne- 
cessary habits are indulged in during the period set aside for 
sleep ; such as drinking water several times in the night, or rising 
too often to discharge the contents of the bladder. If the first 
be indulged in, an artificial thirst will be created; if the second, 
the bladder acquires a preternatural degree of irritability, which 
is almost sure to terminate in the disgusting and inconvenient 
habit of wetting the bed, 

369. After children have risen from their bed, they should be 
dressed as quickly as possible ; they should be carefully washed 
and combed, and then be permitted to inhale the fresh air, either 
in doors or without, with as much freedom «as the nature of things 
will permit. For the first purpose, the nursery should be well, 
but carefully ventilated; or, what is still better, the children 
should be allowed to retire to another room, when practicable, 
and, especially, during the time the nursery is cleaning; hence, 
the propriety of two rooms being devoted to this purpose ; and 
for the second, when the weather is proper, they may be allowed 
to go out of doors, 

370. So soon as the above necessary operations are performed, 
children should have their breakfasts ; so that the stomach need 
not suffer, either from too long fasting, or from the indulgence 
of too great an appetite, excited by long abstinence. 

371. A cradle for young children is a very important appen- 
dage to a nursery, notwithstanding the objections which have 
been made against it, by ingenious speculators upon the subject 
of the physical education of children. The advantages of the 
cradle are, 1st, it can be placed in any situation of the room, 
without disturbing the child, for the advantage of either warmth 
or coolness; for light or darkness, or for air; 2dly, it supplies 



100 OF THE NURSERY. 

the most gentle and certain anodyne, if we may so term it; since 
it will amuse by its motion, when the child is placed in it awake ; 
lull by its sameness, when disposed for sleep ; and perpetuate it, 
when desirable, by a familiarity with its action ; for it must be 
recollected, that, for nine months previously to birth, the child 
has been indulged in the gentlest motion in the fluid in which it 
constantly swims, consequently, the motion of a cradle would 
seem to be but a continuation of an exercise to which it had 
been long used. 

372. The objections to the use of the cradle are easily ob- 
viated. It is said it may produce fatuity, by constantly shaking 
the brain ; this could not possibly happen, unless the cradle were 
violently agitated ; in which case it would be the abuse of the 
cradle that should be objected to; since no such consequence can 
possibly follow its proper use : for, did gentle agitation do mis- 
chief to the organization or functions of the brain, why are not 
all children born fatuitous, since that organ is subjected to it 
from its earliest formation? Another objection is urged, which 
is as easily obviated : it is said the child runs much risk by its 
liability to overset — now, it must be by the employment of ex- 
treme violence, or carelessness, that this can be looked upon as 
an objection to the cradle; for, certain it is, that a proper use 
of this machine can never be attended by such a consequence. 

373. In using the cradle, however, we would suggest certain 
precautions, that it may not be converted into an improper ma- 
chine. We would forbid all violent motions of it, since it would 
not only defeat the objects for which it is employed, but might 
be attended with the risk of oversetting. The motion of the 
cradle should be made an efficient means to procure rest ; and 
should, therefore, not be so constantly used as to lose its effi- 
cacy by too frequently employing it ; nor should its influence 
ever be taken advantage of, to procure more than the necessary 
degree of sleep, as it may tend to the disadvantage of the child; 
nor should we think the cradle necessary to children much be- 
yond the second year, as, at this time, their exercise will dispose 
them to sleep soundly without its agency. 

374. The means by which the nursery is warmed is not a mat- 
ter of indifference. Two important objects should always be 
kept in view, in constructing it — namely : first, security from 
accident to the children; and, secondly, affording sufficient 
warmth. 

375. These may be secured by an open fire of wood, or of coal, 
protected by a high and substantial fender of wire, that the 
children may not approach it too nearly; or by a stove placed 
near the hearth, and defended by an iron railing. We, however, 
should never advise the stove, where an open fire can be made 
use of with equal advantage as regards heat; and we believe 



OF THE NURSERY. 101 

that the introduction of the Lehigh coal will secure to us this 
desirable end, with less expense and more security than any other 
method. 

376. The objections to a stove are numerous, and deserve a 
serious attention — First, there is great danger that the children 
may get severely burned, as we have often witnessed ; Secondly, 
they are almost always too much heated; Thirdly, the air is 
rendered too dry, by a destruction of its moisture, and becomes 
impure by the burning of millions of little particles which are 
constantly floating in it; and though one of these objections 
may be partially obviated by placing water upon the stove, yet 
it will not remove the second ; Fourthly, the air is almost con- 
stantly injured by substances thrown upon the stove, as grease, 
meat, &c. ; Fifthly, there is always a temptation to do some kind 
of cooking upon or in a stove, to the destruction of the comfort, 
or to the injury of the health of the little inhabitants of the nur- 
sery, besides the serious risk of scalding them, by heating water 
upon it. We lately saw an instance of death from this cause, 
and have witnessed many times minor accidents from the same 
source. 

377. We have already forbidden the performance of a number 
of operations in the nursery — we need not repeat them here — 
we shall merely reiterate that the nursery should be the purest 
place in the house, as well as the one in which the children should 
most delight. It should, therefore, never be made a place of 
punishment, by banishing children to it for any little delin- 
quency, or inadvertence, they may have been guilty of; but, on 
the contrary, a temptation should constantly present itself in 
the nursery, by making it the seat of their amusement: children 
will then bear being placed there, without considering it a place 
of confinement, or one in which they are to experience priva- 
tions. 

378. Among the proper provisions of a nursery, we would 
reckon a small backgammon table, with men, but without dice. 
Children, as soon as they are capable of comprehending the 
subject, should be taught draughts, or checkers. This game is 
not only highly amusing, but it also is very instructive, as it calls 
forth the resources of the mind in the most gentle, as well as 
in the most successful manner. It becomes a source of endless 
amusement, as it never tires, and always instructs. 

379. Battledoor or shuttlecock, is also a proper game for the 
nursery; this gives great agility, as well as great vigour to every 
muscle in the body. It exercises with but little fatigue; it gives 
great practical accuracy to the eye and to the hand, while the 
mind is agreeably amused. A large cup and ball should be 
added to the above articles, as it affords great opportunities for 
acquiring skill, as well as excites an agreeable emulation to 
excel. 



102 OF THE NURSERY. 

380. A rocking-horse, of a good size, should also be an ap- 
pendage to a nursery — this article, however, should be considered 
as a luxury, or it will become abused by becoming too familiar ; 
it should, therefore, only be introduced occasionally, and that as 
a reward for good conduct. This will teach children to find their 
seat upon a saddle much easier than they would otherwise do, 
when they are placed upon the back of a living horse. 

381. Slates and pencils afford much employment as well as 
amusement to children — it gives them the habit of making let- 
ters and figures very early, as well as calls forth their imitative 
powers in rude attempts to copy any of the objects of nature, 
or of art, which may present themselves. For the same reason, 
we would indulge children in the use of paper and lead pencils. 

382. To children of proper age, dissected maps, and Chinese 
puzzles, or tangrams, are very acceptable, and highly useful ; 
they exercise the memory, elicit ingenuity, excite a laudable emu- 
lation, and give the habit of patience and perseverance, in tWir 
various attempts to correctly dispose of the one, or discover the 
various combinations of the other. 

383. A quantity of regularly shaped pieces of wood, of va- 
rious sizes, should be given to them ; these they will arrange, 
and that sometimes with great ingenuity, into houses, temples, 
churches, &c, and thus become sincere admirers of each other's 
skill in forming these mimic but evanescent buildings, the de- 
struction of which they ardently wish for the instant they are 
formed; and whose sudden demolition, by a stroke of the hand, 
affords the highest gratification, because they can construct an- 
other with almost as much celerity. 

384. A set of nine pins and balls of proper size affords great 
pleasure to children ; and serves to divert as well as to exercise 
them ; for both of these are highly important, when the weather 
prevents their being taken into the open air. By affording them 
opportunities to exercise their skill, they forget they are con- 
fined; and thus is prevented that peevish discontent, called 
ennui, by which they are sure to be assailed when they have 
nothing to exercise their muscles or to employ their minds. 

385. We might enumerate a number of other sources of 
amusement to children, but almost every parent will supply the 
deficiency as the necessity for variety may present itself. We 
do not, however, approve of sharp-edged or pointed instru- 
ments, for children ; they can serve no possible use, and may be 
productive of serious mischief. We have known the loss of two 
eyes from pointed instruments, and a number of severe wounds 
from sharp ones. 

386. The nursery should be as free as possible from holes or 
crevices, that the children may not be exposed to partial draughts 
of air; and that the air of the room may be preserved in winter 



OF THE NURSERY. 103 

of a pretty uniform temperature. Attention to this will enable 
the children to play in every part of the room, without injury: 
and it will also prevent the desire to crowd round the hearth, 
which will serve to diminish the risk of their clothes taking fire, 
or doing themselves other injury. 

387. Too much care cannot be taken to guard against the ac- 
cident of the clothes taking fire; there is but one security against 
this, when an open fireplace is the means employed for warming 
the room ; namely, by dressing the children in worsted garments, 
or, at least, the outer ones; that is, the frocks and aprons. It 
is but too common to disregard this important precaution ; and 
the accidents are numerous in consequence of the neglect. Many 
are in the habit of dressing their children in proper materials, 
as regards their body clothes, but seem altogether to forget, that 
if these be covered by a muslin or linen apron it may take fire 
and do serious mischief; it is, therefore, not sufficient that the 
under garments be made of woollen materials, if these be sur- 
mounted by an inflammable substance. 

388. Children that can just run about, as well as older ones, 
are almost constantly in the habit of having sharp-pointed sticks 
for playthings; and nothing is more common than to put an end 
of one of these sticks in their mouth, and run with it when it is 
in this situation, at the risk of doing great mischief to the mouth 
and throat, by its being violently driven into them by the force 
of a fall. My friend Dr. Physick related to me a case of lock- 
jaw and death from this cause; and we ourselves. have witnessed 
many less severe accidents from the same source; and we were 
called, not long since, to an accident of this kind, that created 
much anxiety, though it did well eventually. A child was run- 
ning across the floor with a pointed stick of cedar in its mouth ; 
it fell, and the point was forced through the palate, which it 
nearly separated. It produced much suffering, from an almost 
total inability to swallow from the inflammation that was ex- 
cited. 

389. It is also wrong to permit children to run about the 
nursery barefooted, or in their stocking feet, especially if the 
floor be covered by either carpet or mat; as it every now and 
then happens that they run into their feet, needles, pins, nails, 
glass, or other sharp substances that may be concealed in the 
substance of the floor covering. 

390. The introduction of glass into the nursery should be 
avoided as much as possible ; as a constant liability to accident 
is incurred by its being broken and strewed over the floor, and 
by the children treading upon, or handling the pieces. 

391. We cannot recommend too earnestly the frequent venti- 
lation of the nursery. The best possible method to purify the 
air is by the admission of fresh air from without : this should be 



104 OF THE NURSERY. 

done at least daily, by opening the windows and doors for a 
short time. During the process of ventilation, however, the 
children should be removed from the nursery, or protected by a 
screen, from the immediate current of air ; but the former is the 
better plan, as children are not always obedient to the wishes of 
their nurses, and may expose themselves very improperly. This 
ventilation should not be performed if the weather be wet ; as 
the damp air might prove more injurious than the air intended 
to be removed. 

392. No sand should be strewed upon the floor of the nur- 
sery ; as it is always inconvenient to walk upon, as well as fur- 
nishing a great quantity of very fine sharp dust, which is very 
injurious to the eyes when the floor is swept or is otherwise dis- 
turbed. 

393. Some have recommended fumigations of vinegar and 
other substances for purifying the air ; this is neither necessary 
nor availing, especially as we can always command a much better 
article, namely, the fresh external air. 

394. The air of a nursery should be maintained at a pretty uni- 
form temperature — for this purpose a thermometer should be a 
part of the furniture of every well-appointed nursery. It should 
be placed remotely from the fire, and not to face it; as it may, 
if so situated, give a false result, as it will be necessarily affected 
by the radiant heat of the fire. It should never exceed 66° or 
67° of Fahrenheit. The thermometer should be placed out of 
the reach of the children, or it will quickly be destroyed. 

395. We are fully persuaded that the excessive heat of nur- 
series has occasioned a great mortality, especially among very 
young children. In the first place it over-stimulates them ; and, 
in the second, renders them so extremely susceptible of cold, 
that every draught of cool air endangers their lives. They are 
maintained in a constant state of perspiration, which is frequently 
checked by an exposure to even an atmosphere of moderate tem- 
perature. 

396. Children should never be left alone — their helpless con- 
dition requires constant care, especially when very young. They 
should never be left to themselves while feeding, as they may 
choke for want of proper and timely assistance ; nor should they 
be placed upon a chair or table, unless they be well watched. 
The children of the poor very often meet with serious accidents, 
from the necessity the mothers are frequently under, to leave them 
for a time to take care of themselves. A friend lately related to 
me a fatal accident, arising from this cause, which may, perhaps, 
serve as a warning to those who are in the habit of leaving 
children alone, when there is no absolute necessity to do so. A 
poor woman, who had been spinning upon a large wheel, was 
obliged to leave the room for a short time. Before she went, she 



OF THE NURSERY. 105 

placed her child, (an infant who could not walk,) upon the floor, 
some distance from the wheel. She presently heard something 
fall, and her child to scream violently — she ran instantly into 
the room, and found the poor infant transfixed to the floor by 
the spindle of the wheel passing entirely through its body. She 
supposed the child had pulled at the thread she had been spin- 
ning, which was sufficiently strong to overset the wheel. 

397. Animals should not be left with children when alone, for 
both dogs and cats may be provoked to do mischief, if too rudely 
assailed by them. Cats, by common consent, are driven from 
the sleeping places of children, under an apprehension that they 
will "suck the children's breath." If this phrase mean any 
thing, it is that the animal can produce suffocation, by arresting 
either the ingress or egress of the air — a thing altogether im- 
possible, unless the animal should have sagacity enough to stop 
both the mouth and nostrils at the same time; for, should the 
mouth be closed, respiration can be carried on through the nos- 
trils ; should the nostrils be obstructed, it will go on through the 
mouth. 

398. When a night lamp is burned, it should always be placed 
in the chimney-place, or immediately before the door of a stove, 
that the smoke may be carried off. If this be not done, the air 
of the room becomes loaded with lamp-black, to the great injury 
of the lungs. 

399. It is not a matter of indifference in which direction the 
light falls upon the child ; young children eagerly seek it with 
their eyes ; and if it do not fall directly upon the face, the eyes 
will be strained to the direction in which it is strongest. In 
consequence of this, the muscles will contract the habit of 
moving the eyes in an oblique direction, which may terminate 
in squinting. On this account, all objects capable of attracting 
the attention of the child from the vivacity of their colours, 
should never be presented to them sideways, or immediately over 
their heads. 

400. We have already forbidden washing or ironing, or any 
other operation, being carried on in the nursery, which shall 
load the air with vapour ; as it will necessarily expose the chil- 
dren to colds, coughs, or other severe affections of the lungs. 



PART II 



ON THE PHYSICAL TREATMENT OF NEW-BORN, 
AND OLDER CHILDREN, ETC. 



401. For the sake of convenience, as well as of perspicuity, 
we shall divide the consideration of the physical treatment of 
children into the different and marked periods of their lives ; that 
is, from the moment of birth to the period of puberty. These 
divisions will comprise, 1st, the period from birth to that of wean- 
ing ; 2dly, from that period to second dentition ; 3dly, from 
second dentition to the period of puberty. 



CHAPTER I. 



FIRST P ER I OIK 



402. Evert child born alive, and at or near the full time, 
cries as soon as the surrounding air gains free admission into its 
lungs. This grateful sound repays, in an instant, the suffering 
mother for her pain, her anxiety, and her peril; or, at least, it 
produces a temporary oblivion of them. But unaccustomed to 
the sound, and having all her Hfe attached the idea of pain to 
the exercise of the function of crying, she becomes alarmed, 
should this effort be continued any time, and most anxiously in- 
quires "why the child cries so violently?'' 

403. We will endeavour to explain, for her sake, this inte- 
resting question. The child, while in the womb, is surrounded 
by water, and is enclosed within walls, if we may so term them, 
of limited extent. In the first, it floats securely, as it has no 
use for its lungs while thus imprisoned; and against the second, 
it oftentimes tries the strength of its limbs, with much advantage 
to itself, if not always with comfort to its mother. As the me- 
dium in which it floats is of the same temperature as that of its 



108 OF CRYING. 

mother's body, it may be considered as constantly living in a 
warm bath. The uses of this bath are, 1st, to preserve the child, 
as much as possible, from external accidents; 2dly, to give en- 
tire freedom to all its movements ; 3dly, to maintain it in a me- 
dium of uniform temperature ; and 4thly, to preserve the supple- 
ness and sensibility of its skin. 

404. When the little stranger is ushered into the world, how 
changed are all its relations, and all its necessities ! It now be- 
comes almost an independent, though a most helpless being; for 
its immediate connexion with its mother is at once cut off; in- 
stead of a bath of the most grateful temperature, it is plunged 
into an atmosphere almost always a little lower than the one it 
has been in the habit of revelling in; and sometimes into one 
very much below it: and instead of the confined surface against 
which it was wont to exercise its sense of touch, it is now thrown 
comparatively into illimitable space. The first of the changes 
we have mentioned makes a powerful, and doubtless, sometimes, 
a painful impression upon its extensive surface of skin. Its 
little muscles are necessarily thrown into action; and, as a con- 
sequence, the chest becomes expanded, and the air by which it 
is now surrounded enters into its collapsed lungs, and the action 
of "crying " is instituted. 

Sect. I. — Of Crying. 

405. " Crying" should be looked upon as an exercise of much 
importance, both to the immediate and mediate advantage of the 
being. Immediately it is useful, by facilitating the passage of 
blood through the lungs, where, until this moment, it had been 
unaccustomed to travel; but which is now a sine qua non to the 
existence of the being; 2dly, it aids more effectually in the ex- 
pansion of the air cells of the lungs ; thereby presenting a larger 
surface for the action of the atmospheric air, from which the most 
important consequences are to flow ; such as the due oxygenation 
of the blood, on which depends, to a greater or less extent, every 
healthy function of the system ; of the unloading of the system 
of certain materials, the retention of which would be highly in- 
jurious ; and thus contributing either to the direct or indirect 
production of animal heat. The mediate advantage of " crying " 
consists in its giving strength and a proper tone to the organs 
employed in the act, by thoroughly expanding the air cells of 
the lungs; thus early and constantly accustoming them to be 
stretched, at a period the most favourable for this extension ; 
and, at the same time, freeing the lungs from mucus that is con- 
stantly pouring into these cells ; and thus preventing injurious 
accumulations. 

406. It may farther be observed, on the subject of "crying," 



OF CRYING. 109 

that this act is not always an expression of pain; it is intended 
very often as an appeal to the tenderness of the mother, when 
the child is impelled to make its necessities known — hunger and 
thirst, or sometimes, upon much more important occasions to 
itself, namely, uneasiness, from want of change of posture: for 
a constrained situation renders the child not only uncomfortable, 
hut is really injurious to it, if too long continued. The poor 
infant is too often condemned to one position, provided it express 
no objection to it by its cries: the consequences are, 1st, that 
the circulation is much impeded on the side on which it lies, 
from the compression the parts must suffer from the weight of 
the child itself; and 2dly, its limbs are unequally exercised, 
especially when the mother, or nurse, has a favourite side for 
the child to rest upon — this election should never be suffered, 
for reasons too obvious to need mention. We may, however, 
observe, en passant, that the child should not be permitted to 
continue longer than an hour or tw r o, at farthest, in one position ; 
the fear of awaking it should never prevent an attention so im- 
portant to its health. Besides, we know, from ample experience, 
that the child very soon becomes accustomed to the operation 
of turning, or changing its position, and will be almost sure to 
express the relief this alteration affords, by instantly putting 
all its little limbs upon the full stretch, and again "addressing 
itself to sleep." 

407. We would particularly warn mothers and nurses against 
placing the child upon its back ; as this position may be followed 
by very serious consequences, if it chance to throw up the con- 
tents of its stomach — -we once knew suffocation from this cause. 

408. In very young children, there is a rapid accumulation 
of the excitability of the system, arising from their passive con- 
dition, which requires the employment of the muscles to keep 
it down to the healthy point ; and "crying" is the "waste gate" 
to an excess of excitability. This act, therefore, is more easily 
provoked in children, that the equilibrium of excitement and 
excitability may be preserved. " Crying " is most useful in many 
instances, for the same reason, even to the adult: — who has not 
witnessed the relief afforded by a gush of tears, to an oppressed 
heart? — and, in our practice, we take advantage frequently of 
the circumstance, by permitting, nay, sometimes soliciting 
"cries" at the trying and important moment of a woman beco- 
ming a mother. 

409. To show, farther, the importance of this act, by creating 
a diversion of the excitability and excitement, Dr. Rush used to 
relate to us in his lectures the case of a gentleman in South 
Carolina, who was about to be cut for the stone. This gentle- 
man thought it beneath the dignity of a man to express pain 
upon any occasion ; he, therefore, refused to submit to the 



110 OF CRYING. 

usual precaution of securing the hands and feet by bandages, 
declaring to his surgeon he had nothing to fear from his being 
untied, as he would not move a muscle of his body — and he truly 
kept his word ; but he died instantly after the operation, from 
apoplexy. In this case the excitability and excitement were 
too much accumulated in the brain; and it yielded to their influ- 
ence from the want of some outlet for the one, or diversion for 
the other. Besides, there are other important things connected 
with crying, by a careful study of which we may learn much. 
I cannot do better than transcribe M. Billard's remarks upon 
this important point. He says, "When we give but a slight 
attention to the cry of a child, we hear nothing but a uniform 
noise; the vagitus, or cry of a new-born child, is always easily 
distinguished from the other noises which constantly strike the 
ear ; but if we listen more attentively, we shall discern that the 
cry is composed of two distinct parts, the one sonorous and pro- 
longed, only heard during expiration, ceasing and commencing 
with it, and caused by the air passing from the lungs through 
the glottis. This is the proper cry. The other part is produced 
bj inspiration ; the air, in passing through the glottis, in order 
to reach the lungs, is compressed by a kind of spasmodic con- 
traction of the vocal muscles, giving a shorter and more acute 
sound than the proper cry, and often less perceptible ; it is an 
interval, a sort of effort at renewal between the cry just finished 
and that about being commenced. Often the cry exists alone, 
and the sound of the interval, or reprise, is not heard at all; or 
the reprise is heard, while the cry is stifled. The cry and the 
reprise often have very important modifications with which it is 
necessary to be acquainted, and which we will hereafter point 
out. The younger the infant, the less the reprise is heard ; it 
very sensibly increases as the child advances in age; the sound 
varies from the whistling of the blowing of wind to that of 
the shrill voice of a young cock. It appears to augment in 
intensity in an inverse ratio to that of the cry. When the child, 
after having cried a great deal, becomes exhausted by fatigue, 
want of sleep, or pain, the reprise then predominates : this is 
the sound which is heard from time to time in the sobs of a child, 
finally terminating in profound sighs elicited by the recollection 
of recent pain. 

" The peculiar tone of the cry varies as much as the voice in 
adults. It exhibits in each infant particular modifications, which 
it is difficult to describe, but which are easily discerned by the 
ear. The heart of a mother responds not to the cries of strange 
children, but her own cherished one is immediately recognised 
among all others. 

"From what we have seen, the cry is really nothing more 
than a sonorous inspiration and expiration. The infant might, 



OF SLEEP. Ill 

therefore, be expected to exhibit, while crying, the effect of 
painful and forced respiration in the muscles of the face and 
trunk." p. 37-38. 

"Pain is a frequent cause of crying. The cry caused by pain 
is remarkable for its strength, frequency, and obstinacy, and may 
be known by the particular expression of the face with which it 
is accompanied, very difficult indeed to describe, but which may 
be easily recognised by the general condition of the child, such 
as pallidness, wasting, and an aversion to the breast. It may 
also be known by the assemblage of such symptoms as designate 
the existence of disease in some part of the body. The sound 
and form of the cry excited by pain, are likewise influenced by the 
organs affected: these modifications will be pointed out below." 
p. 43. 

" The cry exhibits varieties in the form, tone and duration, — ■ 
the form may be incomplete, laborious, and smothered, — the 
tone may be acute, grave, husky, and tremulous, — the duration 
may be short or frequent and interrupted," p. 44. — Dr. Stewart's 
Translation, p. 38. 

410. But, in attaching so much consequence to "crying," 
we are not to be supposed to advise either the provoking of it, 
or perpetuating it by artificial means; nor to consider this act 
as always expressive of either pain or uneasiness ; or to require 
the interference of the mother or nurse; for, on the contrary, 
we are fully aware how readily a habit of crying is generated, 
by a too prompt attention to the demands of the child; and, 
also, that the most clamorous children are those you are the 
most solicitous to appease. Crying may, however, be indicative 
of disease; it will, therefore, be considered again under this 
head. 

Sect. II.— Of Sleep. 

411. New-born children may be said to sleep constantly; 
their waking moments furnish but exceptions to the rule. This 
is a wise regulation of nature, since it permits a renewal of the 
excitability, as fast as it is expended. In this early stage of 
life, the gastric, the arterial, and the absorbent powers, are 
much employed for the purposes of digestion, of secretion, of 
deposition, or growth; and, consequently, much excitability is 
required for the various contingencies now mentioned. And, it 
would seem, in general, more is generated, if we may so express 
ourselves, than is absolutely necessary, as it has to be carried 
off, as just noticed, by occasional crying, &c. This passive con- 
dition of new-born children is highly favourable to the healthy 
expansion of the body, for, where this is interrupted by some 
derangement of the nervous system, which declares itself by too 
frequent crying, and watchfulness, the child ceases to thrive. 



112 OF SLEEP. 

412. It is some time before the nerves of hearing appear to 
be affected by sound; hence, we see children almost insensible 
to loud noises, even weeks after their birth. This appears to 
be an especial care of Providence, that the important state of 
sleep should not be too easily interrupted. This sense, however, 
after a time, becomes exquisitely sensible ; and, if it were to be 
too much indulged, by not permitting the child to become fami- 
liar to it, and that as early as possible, much mischief would 
arise. 

413. We have often been consulted upon this occasion : over- 
careful mothers think, that sleep should never be abridged, nor 
interrupted; they, therefore, keep their nurseries so extremely 
silent during the sleep of the child, that it is constantly awakened 
in much alarm, whenever any sudden or unexpected noise assails 
its ear ; we have known children many times rendered so sensible 
to noise during sleep, as to be roused by even a light tread upon 
the floor; and when a louder noise had been made, to awake 
almost in convulsions, and always in extreme fright, and loud 
crying. To guard against these evils, and they are evils of 
much greater magnitude than might at first sight appear, since, 
in many instances, they have been perpetuated through life, we 
therefore, constantly recommend, as a practice in all nurseries, 
to let the child fall asleep in the midst of noise, and never to 
consign the room to strict silence, as a precaution, during the 
whole of its nap. If children be habituated to fall asleep while 
surrounded by noise in the nursery, and not have that noise 
interrupted by design during the continuance of sleep, they will 
soon support any common degree of it, without the least agita- 
tion, or other inconvenience. 

414. Much advantage is derived from this plan — 1st, a morbid 
sensibility of the organs of hearing is not generated; conse- 
quently, the child will be exempt from all the evils and incon- 
veniences this condition would inflict; 2dly, the functions of 
the body will be better performed, since they will not be inter- 
rupted by the repeated wakings of the child; 3dly, the child 
will derive all the advantages which an undisturbed sleep will 
give ; 4thly, we can better calculate on the duration of its sleep ; 
5thly, it will save its mother or nurse much unnecessary anxiety, 
as well as trouble. 

415. If the habit of stillness during sleep have been established 
in the nursery, the quicker it be broken the better : this, if properly 
attended to, can be done in a short period; 1st, by obliging the 
child to fall asleep during a moderate noise, by not abstracting 
the noise from it — it will contend for some little time, but not 
long; 2dly, by continuing the noise during the period of sleep; 
by this plan it will soon become familiar to it, and after awhile 
may even sleep better than before. 



OF THE AIR. 113 

Sect. III. — Of the Necessities of the Child. 

416. The necessities of the child are no less remarkably 
changed than its relations. It must now breathe a pure air, or 
it dies; it must now receive and prepare food by the operation 
of its own stomach, for the purposes of its system, or it sinks : 
it must now be protected against the variations of temperature, 
or it perishes. In a word, a new kind of life commences from 
this moment; and, that this may be preserved in the best possi- 
ble manner, is the end and object of Physical Education. It 
will now be easily understood why this species of education should 
commence at the period we have assigned to it; since it will be 
obvious that the more perfect the health of the individuals who 
niarry is, the better the foetal life has been conducted, and the 
more successful will physical agents be, in properly developing 
and perfecting the animal life, which is to follow. 

417. It will be seen that the body is now to be subjected to 
the influence of entirely new agents ; and these may be considered 
under several distinct heads, as follows — 1st, Air; 2dly, Food; 
odly, Clothing; 4thly, Exercise ; othly, Cleanliness. The agents 
we have just enumerated exert a prodigious influence upon the 
welfare of the being on whom they are to act ; their operations 
commence with the first moments of animal life ; and they are 
perpetuated, under one modification or another, to the last period 
of human existence. We shall, therefore, take up the considera- 
tion of each of these powers, in the order we have placed them — 
and, first, of Air. 



CHAPTER II. 

OF TME AIR. 

418. By the air we mean that immense mass of permanently 
elastic fluid, which surrounds the globe we inhabit. This sub- 
stance is absolutely essential to the continuance of life in every 
species of animal; and its effects upon the human system are 
healthy, or otherwise, in proportion to its purity. But this con- 
dition must be constantly varying, as it may lose one of its prin- 
ciples, or as it may receive an excess of another; or be loaded 
with noxious exhalations from vegetable, animal, or mineral sub- 
stances, especially in great cities. 

419. Modern chemistry has done much to illustrate the con- 
dition of our atmosphere, by pointing out the means by which it 
retains its vital purity, as well as by informing us in what this 
vital purity consists, and the manner in which it becomes de- 



114 OF THE AIR. 

teriorated. Until the discovery of oxygen as a component 
part of our atmosphere, it was altogether conjecture, as to 
what it lost or gained, by combustion, respiration, or vegeta- 
tion. The phenomena of combustion, and of respiration, were 
well marked and described by the ancients ; but their reasoning 
upon the causes of the changes which the air underwent by these 
processes, was altogether founded upon assumed principles ; and 
the world was not much enlightened upon this subject, until 
oxygen was simultaneously discovered, by Scheele in Sweden, 
and Priestley in England, to be a constituent of the atmosphere ;* 
though Mayo, two hundred years before, had nearly arrived at 
the same discovery and conclusion. 

420. For the discovery of the chief means by which the atmo- 
sphere maintains its purity, we are indebted to the experiments 
of the ingenious Dr. Ingenhouz. He found that plants of every 
kind, while growing, and acted upon by the sun, yielded this 
salubrious air — the deadly nightshade, and the most innocent 
plant, alike gave out this gas. 

421. There is, therefore, every reason to believe, that the 
atmosphere in its extended sense, is as pure now as in the days 
of the patriarchs. If, then, life be shorter now than it was at 
that period, (a circumstance, perhaps, wanting proof, 2 ) it is cer- 

1 It was soon found, after the discovery of oxygen, that this substance is essen- 
tial to combustion; and, very quickly after, that it is equally so to respiration. 
Priestley made many decisive experiments upon this point — and, since the term 
of vital air was given to it, as one of synonyme. 

a HufBand says, " It is commonly believed, that during the early periods of the 
world the lives of its inhabitants were more youthful and more perfect; that those 
primitive men had a gigantic size, incredible strength, and a most astonishing du- 
ration of life. Some have not hesitated seriously to ascribe to our forefather 
Adam the height of nine hundred yards, and the age of almost a thousand years. 
But the rational and accurate investigation of modern philosophy has converted 
the supposed size of giants, found in different parts of the world, into those of 
the elephant, and rhinoceros, (and, we may now add, the mammoth,) and acute 
theologists have shown that the chronology of the early ages was not the same 
as that used at present. Some, particularly Hensler, have proved, with the highest 
probability, that the year, till the time of Abraham, consisted of only three months ; 
that it was afterwards extended to eight ; and that it was not till the time of Jo- 
seph that it was made to consist of twelve. These assertions are, in a certain 
degree, confirmed by some of the Eastern nations, who still reckon only three 
months to the year." But, however much calculators may differ in the supposed 
ages to which antediluvians may have attained, we have strong reasons for be- 
lieving, that in the time of Moses, the chronology was, perhaps, absolutely the 
same as at the present moment. The opinion, however, we must confess, is de- 
duced rather from circumstances, than absolute facts; and relies for its support, 
almost altogether, upon analogy. Thus, Moses informs us, " The days of our 
years are threescore and ten; and if, by reason of strength, they be fourscore 
years, yet is their strength labour and sorrow; for it is soon cut off, and we fly 
away." Ps. xc. Again, in the time of David, five hundred years after Moses, 
when Barzillai excuses himself for not visiting the royal palace at Jerusalem, he 
observed to the king : — 

"I am this day fourscore years old, and can I discern between good and evil 1 
Can thy servant taste what I eat, or what I drink? Can I hear any more the 
voice of singing men, and singing women? Wherefore, then, should thy servant 
be yet a burden unto my lord the king?" — American Quart. Rev. No. 16, p. 364. 



OF THE AIR. 115 

tainly not owing to a defect of purity in the general atmosphere. 
It must have its foundation in circumstances, independently of 
any general atmospheric impurity. 

422. These circumstances, we are of opinion, are the changes 
in the habits and manners of mankind at present, from those in 
the time we have just alluded to. Formerly, man was simple in 
his mode of life, and laborious in his habits ; his occupations were 
confined very much to those of the hunter, the shepherd, or the 
tiller of the earth. 

423. From this it would seem to be ascertained, that air may 
be either pure, or be more or less deteriorated, as it may be sub- 
jected to such causes as may be capable of altering its chemical 
or sensible properties. The chemical properties of the air are 
principally affected by combustion and by respiration ; and the 
changes which it may undergo are in proportion to the extent or 
degree of the one, or the continuance of the other. 

424. But, to make this better understood by those who have 
never devoted any time to the subject, it may be necessary to 
state that the "atmospheric air" is principally composed of two 
distinct substances or gases, in certain proportions to each other. 
One of these is called oxygen, the other nitrogen. It is the 
former which maintains combustion and supports respiration ; 
for these processes can be continued as long as this exists in the 
combination, and the perfection of either will depend upon the 
due proportion of oxygen. It must, however, be remembered, 
that an excess of oxygen does not do any material injury to 
either. Besides these we may mention a small quantity of car- 
bonic acid gas. 

425. Now, as combustion and respiration are always going on 
in the habitable world, it follows there must be a constant loss 
of oxygen ; and if there were no sources or means, by which it 
could be supplied, the "atmospheric air" would be constantly 
suffering deterioration, even until it were exhausted of its vital 
principle. But a kind Providence has permitted a supply of 

From this it would seem, that at that time the age of fourscore was an excuse 
for the neglect of ceremonious duties ; since it appears to have been attended with 
all the defects now common to the age "' of fourscore:" — impaired moral per- 
ception; diminished taste, or appetite; loss of sight; and hardness of hearing. 
It would, therefore, be safe to conclude that longevity was not greater than 
in our own times. Indeed, we might even plead improvement, agreeably to the 
following statements: — "The census, established from time to time in England, 
affords us information of an unquestionable kind. The first actual enumeration 
of the inhabitants was made in the year 1801. It gave to England and Wales a 
population of 9,168,000, and a mortality of 204,434, or 1 in 48. The second was 
made in 1811. The population was then 10,502,900, and the mortality 1 in 50. 
And the third and last, which took place in 1821, gave an enumeration, according 
to Mr. Rickman, (who was appointed by the secretary of state for the home de- 
partment, to digest and reduce into order the population returns, and by the privy 
council to arrange the parish register returns,) of 1"<;,218,500, and a mortality of 
1 in 58." And this might be extended to other countries. — Amer. Quart. Rev. 
JYc 16, p. 388. 



116 OF THE AIR. 

oxygen in as great proportion as it is taken from the atmosphere ; 
and, by new processes, its qualities in a general sense are main- 
tained at all times in pretty nearly the same degree of purity. 

426. The means by which the lost oxygen is supplied are no 
less certain than extensive; thus, all the living vegetable world 
emit it, as long as they are operated upon by sunshine; and the 
decomposition of water furnishes another extensive source of 
supply. 

427. From what has been said it will readily appear that com- 
bustion, and respiration, which is, in fact, a kind of combustion, 
tend to diminish this vital property of the air; and in proportion 
to that loss, it is unfit to maintain either; it must be, therefore, 
evident that the air which has been once breathed is less fit for 
another operation, in the exact proportion to the diminution of 
the oxygen it may have contained ; and, if this process be suffi- 
ciently long continued, it will be entirely exhausted, and in its 
place will be found a quantity of carbonic acid gas, equal to the 
removed quantity of oxygen, combined with the usual or original 
bulk of nitrogen ; neither of which is respirable alone. Hence, 
the air of great cities is necessarily less pure than that of the 
surrounding country — 1st, by having more causes constantly 
operating to destroy its chemical, and to alter its sensible quali- 
ties ; and, 2dly, by having fewer means to restore the expended 
oxygen, and to abstract from it its carbonic acid gas, &e. 

428. Independently of the greater consumption of vital air 
and the inadequate means in great cities to supply it, there are 
other causes constantly operating to render it still more impure, 
than respiration alone. Combustion, fermentation, and exhala- 
tions from putrid and other bodies, all tend to deteriorate the 
already too much impaired air ; and, consequently, will render 
cities less healthy than the surrounding country, and, perhaps, 
pretty constantly in the proportion we have mentioned. 

429. Therefore it is no way surprising, that the mortality 
among children should be excessive in cities, since their stamina 
are incapable of supporting either the loss of so much oxygen 
or the influence of the various miasmata by which they are con- 
stantly surrounded — hence, agreeably to calculation, more than 
one-half of those who are born, die before the third year. It is 
true we must not attribute this excessive mortality exclusively 
to the causes just mentioned; there are others constantly opera- 
ting to produce this effect, especially among the poor ; such as 
bad nursing, and perhaps worse feeding. 

430. Rousseau, with a mixture of truth and prejudice, inveighs 
bitterly against men shutting themselves up in cities — he says, 
u Mankind were not formed to be heaped together in shoals, but 
to spread themselves over the face of the earth, to cultivate it. 
The more they assemble together, the more they corrupt each 



OF THE AIR. 117 

other. Man is, of all animals, the least adapted to live in herds. 
Flocks of men, like flocks of sheep, would all perish in a short time. 
Their breath is destructive to their fellow creatures; nor is it 
less so in a literal, than in a figurative sense." In these few 
sentences we see at once his plan of education, and the impos- 
sibility of reducing it to practice; for all could not become cul- 
tivators of the soil, any more than they could be all shoemakers 
or tailors. And, though we admit that cities are less healthy 
than the country, yet all men could not live in the country; and 
cities ever have, and always will be built from the very nature 
of things. Nor is it difficult to foresee the consequences, should 
the genius of man tempt him to spread himself widely over the 
face of the earth, and all become cultivators of the soil: other 
evils would necessarily arise, which would be equally destructive 
of human life. 

431. Look at man in this condition, wherever he may be 
found, and what is it we see? Neither a more rapid increase 
of population, more brotherly love, greater longevity, nor greater 
improvement of the soil ! And, though we admit there may be 
a greater exemption of disease in the country, it does not secure 
a greater share of either happiness or population. Indeed, if 
we may credit what is found in books upon the relative conditions 
of man in a savage and in a civilized state, it would appear, that 
cultivation of the mind is even favourable to longevity; and 
though there may be more general health in a savage state, 
there is less length of life. The instances of longevity among 
our aboriginals are fewer than in refined life ; so that what one 
gains by a greater freedom from disease, the other acquires by 
an increase of years. Rousseau's scheme of happiness for man 
is, therefore, altogether Utopian. 

432. In this country, the evils of cities are more limited than 
in those of Europe : they are, first, less populous ; 2dly, they are 
better ventilated by the breadth and regularity of their streets ; 
3dly, there are much fewer manufactories carried on in them ; 
4thly, there is less poverty, or, in other words, there are greater 
facilities of life. 

433. During the summer, our cities become unfriendly to our 
very young population, and much benefit is derived by carrying 
them into the country, when health has failed in the city. .But 
this favourable change is not owing altogether to the purity of 
the country air; much depends upon taking children from the 
remote causes which produce the disease. That this is the case 
in many instances, we are entirely convinced by the fact, that 
children attacked with disease in the country, are very often 
benefited by their being brought to the city — this is familiar 
to every practitioner, as well as to very many others who are not 
physicians. 



118 OF THE AIR. 

434. We are also certain that the country air is not made the 
hest possible use of, by those who inhabit cities; for no sooner 
does the warm weather commence, than they leave the city ; and 
this when the children are in perfect health. In consequence 
of this they become accustomed to the air of the country, as well 
as liable to any epidemic or local influence that may exist there. 
The object of leaving the city is now defeated; since it cannot 
preserve health to those who fly to it for refuge; and it is found, 
cseteris paribus, as difficult to cure a disease originating in the 
country, as in the city — nay, as we have observed above, the 
patients are sometimes obliged to return to the city to get well. 

435. We are persuaded, those who profit most by the change 
of air are those who repair to it as a remedy: children who have 
suffered, or are about to suffer, from the heat of our cities, derive 
immediate, as well as permanent advantage from the change; 
but when taken to the country early in the season, they appear 
to us, to be as liable, or nearly as liable, to disease, as if they 
had remained in the city. Nor is this to be wondered at : they 
are surrounded by the remote causes which produce disease 
in the country; (for no one will deny that the country is not 
obnoxious to disease as well as the city,) besides being liable to 
exposure to dews, both in the morning and evening, under the 
pretence that a walk early in the morning, as well as in the even- 
ing, is wholesome ; as if wet feet and draggled skirts would not 
destroy all the advantages of these early and late walks. They 
are surrounded bj the temptation of fruit in all stages of im- 
maturity, which we well know they do not resist; but, on the 
contrary, they literally cram themselves to surfeit more than 
once in the twenty-four hours. Need we wonder at their being 
attacked by disease? 

436. We have every reason to believe that were proper atten- 
tion bestowed upon children during the period of teething; if 
proper regard were paid to their food ; if due pains were taken 
with their clothing; and if a well-regulated system of exercise 
were established ; there would be much less occasion for country 
excursions for the benefit of health. We shall attempt to ex- 
plain these various and important topics in the course of our 
present work, and in such a manner as will make the putting of 
them in practice easy to every understanding. 

437. Kousseau, in his ardour to recommend a country life, 
becomes, like most speculators upon human conduct, inconsistent 
with himself. His first great object is to oblige every mother 
to suckle her own child ; yet he says they must " send their chil- 
dren to regenerate themselves in the country." Is it practicable 
for every mother to retire to the country during the first two or 
three years of their children's lives? — or to desert their home 
and families, as her children may present themselves? If they 



OF THE AIR. 119 

cannot do this, they must, agreeably to this scheme, commit the 
charge of their children to hirelings ; the very thing he so loud- 
ly deprecates. Of the same nature is his advice to pregnant 
women, when he recommends them to lie-in in the country, in- 
stead of returning to the city for this purpose. How few could 
do this without creating greater evils than it is even intended to 
cure. But to return. 

438. The proportions of these gases in forming the atmo- 
sphere are as follow: in one hundred parts of atmospheric air 
there are of 

Oxygen, 20 parts, 

Nitrogen, or Azote, 80 do. 



100 3 



These proportions, we are aware, are not rigidly exact ; but they 
are so nearly so as to render a mention of their fractions un- 
necessary, when treating this subject in a general manner. 

439. It must, however, be recollected, when we speak of an 
impure air or atmosphere, we are not to be supposed to mean, 
strictly, a mere diminution of oxygen ; for the air may be so 
filled with impurities as to render it highly dangerous to be 
breathed without its oxygen being diminished in the smallest 
degree. Thus, marsh miasmata, the contagious principle of small- 
pox, measles, &c, may be floating in an atmosphere which may 
have its oxygen in full proportion. And it must be farther ob- 
served, that a full proportion of oxygen does not, by any means, 
prevent the influence of these noxious qualities upon the human 
constitution. It is, therefore, necessary to distinguish between 
an impure air and an irrespirable one: the one giving rise to 
disease, the other preventing respiration. 

It may be asked, if this be true, of what advantage is the 
oxygen of the atmosphere to the human constitution, if it have 
not a conservative power ? The answer is as easy as it is satis- 
factory. Experiment has clearly proved — 1st, that this substance 
is absolutely necessary to respiration; and respiration is essen- 
tial to life; 2dly, that this gas performs also important offices 
within the system; for, should the blood not be duly supplied 
with this fluid, it would be rendered unfit for the purposes of the 
circulation; consequently, all the functions dependent upon this 
process must be imperfectly performed, and life itself would soon 
cease. 

440. But it would be an error to suppose that the more there 
is of oxygen, the better for animal life. This is by no means 
true; since this gas is so ethereal and stimulating, as, if too 

1 This mixture of air is not rigidly correct — the proportions being a little differ- 
ent — but they are sufficiently so for our purpose. 



120 OF THE AIR. 

freely indulged in, to make us live too fast. We can give abun- 
dant proof of this in the air of the glaciers, which is of the 
greatest purity, but is rather prejudicial to health. In it we 
consume too fast, if we may be allowed to retain the figure that 
respiration is a combustion ; and the temperature is also too va- 
riable. 

441. Besides, Switzerland, the highest land in Europe, fur- 
nishes fewer instances of longevity than Scotland; and the causes 
of this are obvious — 1st, the atmosphere, at all great heights, is 
too dry ; consequently, too much moisture is detracted from the 
body, as its capacity to receive our fluids, and hold them in so- 
lution, is in proportion as it may be free from them ; 2dly, the 
variableness of the temperature, which always obtains in higli 
situations, is extremely prejudicial to the duration of life. 

442. On this account islands and peninsulas are more favour- 
able to long life than continents. For the temperature of the 
atmosphere is much more certainly preserved in the former than 
on the latter; and the sensible qualities of it have a very de- 
cided influence upon animal life. The weight and temperature of 
the air, and especially the uniformity of these, have a great ef- 
fect upon the human body. Wherever these are the most uni- 
form, it will be found, (cseteris paribus?) most favourable to old 
age — hence we are told that men live longer in the islands of the 
Archipelago than in the neighbouring countries of Asia ; in Cy- 
prus than in Syria; in Formosa than in Japan and China; and 
in England and Denmark than in Germany. 

443. From what we have said, it would appear that the health- 
fulness of a place is not to be determined by the purity of the 
air, or rather by the quantity of oxygen which may enter into 
its composition; therefore something else is required, as we have 
already attempted to show, such as location, soil, cultivation, &c. 
And, farther, that oxygen, as before suggested, cannot interrupt 
the action of various poisons, especially such as may be considered 
the remote causes of fever. Yet this fluid is indispensable as a 
constituent of the air ; and, though its presence cannot protect 
against disease, yet its absence is certain death to the animal 
that is obliged to breathe an atmosphere from which this has 
been withdrawn, or is already consumed. 

444. Hence, great cities are so unfavourable to the extension, 
or even the continuance, of human life. It is calculated that in 
London, Paris, Vienna, and Berlin, between the twentieth and 
twenty-third part of the population die annually ; while in the 
surrounding countries, the mortality does not exceed a thirty- 
fifth or fortieth part. This difference in the mortality of the 
respective places just mentioned is, however, in a great measure, 
owing to the destruction of too large a portion of oxygen. If 
the population become still more dense, the mortality is still 



OF THE AIR. 121 

greater; and when many are crowded together, as in ships and 
prisons, the destruction is yet greater; and if the quantity of 
air be still more limited, the effects are awful ; as was witnessed 
in the Black Hole of Calcutta, where a hundred and forty-six 
men were confined in a narrow space for twelve hours, out of 
which number a hundred and twenty three died. 

445. It is, therefore, evident, that no greater mischief can be 
offered the human lungs, than the want of a due supply of oxygen ; 
consequently, the cruel and absurd practice of covering the head 
of a new-born child, or very young children under the bed- 
clothes, cannot be too severely reprehended. The consequences 
of this practice can be readily anticipated, from what has already 
been said; though it may carry conviction more readily, to ex- 
plain the changes which constantly take place when the child 
is so circumstanced. In placing a child under cover in the 
manner just mentioned, it must, necessarily, be placed in a space 
with a limited quantity of air. Of this quantity, a certain por- 
tion is drawn into its lungs by every inspiration, and returns it 
again with a loss of a part of the oxygen ; the place of the oxygen 
is supplied by an equal quantity of that noxious or irrespirable 
gas, called " carbonic acid gas." Another, and another quantity 
is taken in, with precisely similar results, until, by the repetition 
of this process, every particle of oxygen is abstracted, and its 
place a,s constantly supplied by carbonic acid gas ; and, this not 
being respirable, the child dies, unless it be timeously exposed 
to the fresh air. 

446. An objection as serious may be made to the habit of 
many women, of keeping the child at the bosom all night, with 
its head closely covered with the bed-clothes: the objections just 
urged will operate in equal force in this as in the former in- 
stance; as there is constantly emanating from the surface of 
every living body a sensible and insensible perspiration, as well 
as an extrication of carbonic acid gas. If the body be covered 
closely, and the escape of this gas prevented, the air surrounding 
the body, thus covered, is very soon found unfit for the purposes 
of respiration. 1 Therefore the child is sometimes plunged into 
an atmosphere already rendered impure by the body of the 
mother or nurse, and, consequently, in a short time, has less 
oxygen than is necessary for the purposes of respiration ; and 
it perishes even at its mother's bosom. We have witnessed four 
instances of death from this cause. 3 

1 If a candle be placed beneath the bed-clothes along side of a person that has 
been closely covered all night, it will be quickly extinguished, from the excess 
of carbonic acid gas. 

* We cannot better illustrate the injurious consequences arising from this prac- 
tice, than by stating, that in Great Britain alone, there perished forty thousand 
children, by the practice of nurses permitting the children to sleep near them 
from the year 1686' to 1800. — Friedla?ider , s Education Physique. 



122 OF TEMPERATURE. 

447. It will be easily deduced, that every deterioration of the 
air must be injurious to the child, precisely in the proportion to 
the degree; consequently, the utmost care is required, that no 
unnecessary process by which the air can be injured, should be 
carried on in the room or nursery, in which the child is kept. 
Hence, the decided impropriety of too crowded a room ; of 
washing, drying, and ironing the things intended for the child 
or children's use; permitting the wet or soiled articles taken 
from the child to remain long in the room ; burning of charcoal 
or other combustible substances outside the chimney place; 
cooking of the various articles for meals; the too frequent wet- 
ting of the floor; smoking of tobacco; burning of oil, with too 
long a wick, &c. In a word, the nursery should be, if possible, 
the purest place in the house. We have had occasion already 
to advert to this subject, when treating on the nursery. — (350, 
&c.) 

448. We cannot well condemn, too severely, the filthy prac- 
tice, in too many nurseries, of drying the wet and soiled articles 
in the room with the child. If an article must be used a second 
time after having been once wetted, it should, at least, be re- 
moved from the nursery for the purpose of drying. But a much 
better practice would be to consider a well wetted diaper as 
unfit for reapplication, until it has been washed. The same 
may be said of every other article belonging to the child, that 
has been wetted by its discharges ; as its petticoats, sheets, bed, 
mattress, &c. 

449. The value of a pure atmosphere does not cease at any 
period of the child's life; it is highly important at all times; 
though, perhaps, not so immediately essential, as during the first 
few days of its existence, as it is then less able to bear an impure 
air, than when it becomes older. 

If the directions we have just given be attended to, many 
sources of impurity will be removed, yet it will not amount to 
absolute security. Therefore, frequent ventilation is of much 
consequence ; by this the great mass of the air is removed, and 
its place supplied by that of a better quality. In doing this, 
however, some care is necessary, or the child may receive injury, 
by either partial streams of air passing over it, or by having 
one of too low a temperature applied to it. 

Sect. I. — Of Temperature. 

450. Children of tender age should never be suddenly sub- 
jected to great changes of temperature, 1 whether the change be 
from a higher to a lower one, or the reverse; therefore, children 

1 Nor should their eyes be exposed to sudden and strong light. We have fre- 
quently seen inflammation of these parts follow such incautious conduct. 



OF TEMPERATURE. 123 

born in a cold climate, and in cold weather, cannot safely be 
placed suddenly in a very cold atmosphere, without great and 
immediate risk. It is true, we may guard their bodies against 
the influence of cold so effectually as to receive no injury ; but 
we cannot protect much more important parts with the same 
certainty — for their lungs must receive the cold air within them ; 
and hence the danger. 

451. But the danger just alluded to does not arise so much 
from the immediate effects of cold air upon these organs, as from 
the subsequent action of the warm air, in which they must ne- 
cessarily sooner or later be placed. Violent reaction soon follows 
the state of torpor which the cold air imposed upon the lungs ; 
and inflammation, catarrh, or cough, will almost certainly be the 
result. 

452. A sudden attempt to "harden a child/' as it is called, 
in cold weather, is but another determination to see how much 
a child can bear, without dying under the experiment. This 
scheme, a scheme founded neither on reason nor experience, 
has had, to our certain knowledge, too many victims for us not 
to caution parents against the preposterous and dangerous prac- 
tice. 

453. We would ask, what has given rise to so decided a pre- 
ference in favour of the system of exposure? This question 
would be difficult to answer, upon rational principles or correct 
observation. It has proceeded, without doubt, from some com- 
mon fact relating to the effects of cold ; as the general bracing 
power of a pretty low temperature upon the body ; but without 
taking into view the various circumstances which were essential 
to its favourable operation ; for instance, with the mercury down 
to 10° of Fahrenheit, let two men, (every circumstance being 
equal but that of clothing,) engage in such an atmosphere, at 
any kind of active employment, for a certain number of hours; 
the one to be sufficiently clad to prevent, when at rest, any very 
great inconvenience from the cold; and the other not so well 
protected; the latter, in this case, would require additional 
exercise to prevent suffering. At the expiration of the assigned 
period, what would be the respective situations of these men ? 
The one would be found to have performed his task without 
difficulty, or much fatigue; the other would be seen to have 
performed either less work, or be more exhausted: for, in order 
to do the same quantity of work as his companion, he would 
have to labour much harder to keep up the same degree of ani- 
mal heat; or he will have performed less, and have suffered 
more from the benumbing effects of cold. This is found to be 
the case also with animals, especially horses. Where, then, is 
the advantage of this sudden attempt at bracing by cold? Be- 
sides, as regards the human constitution, and especially that of 



124 OF TEMPERATURE. 

children, it is agreeable to the observations of all medical men, 
that those children who are properly and sufficiently clad, are 
freer from disease than those injudiciously exposed for the pur- 
pose of hardening them. 1 

454. But it is, also, undoubtedly true, that those who may 
have survived the ordeal of ill-conducted winter exposures, are 
generally best confirmed in their after health; but this only 
proves the strength of original constitution, since it stood the 
severe tests to which it had been exposed ; but we are not in- 
formed of the fifty-fold failures of the experiment. Let us apply 
this reasoning to the effects of extreme heat upon the constitu- 
tion, and see how ill the analogy, though correct, will support 
the practice of "hardening, 1 ' or how few would be willing to 
have recourse to the trial. It is a matter, notorious to every 
one, that the emigrants to the West India islands, or other hot 
climates, who survive the "seasoning," enjoy, for the most part, 
the best possible health: and, perhaps, these places will furnish 
as many instances of longevity as almost any other parts of the 
world; but would any one give these instances as proofs of the 
healthiness of an exposure to a tropical sun, or as a means to 
acquire long life? Would not any one, to whom such a propo- 
sition was made, directly declare that the great number of vic- 
tims to the few instances of success are entirely concealed? 

455. It would seem to be a point acknowledged by all writers 
upon the treatment of children, that extensive and deadly effects 
are constantly witnessed, from the variability of climate, and 
from unnecessary, or from unavoidable exposure in cold weather. 
The great increase of acute as well as of chronic affections during 
the winter, would seem to confirm this impression. In our mu- 
table climate, the consequences of unavoidable exposure of the 
children of the poor to its inclemencies are familiar to the ob- 
servation of every one who may have felt an interest in the 
claims of humanity; and so far as we can recollect from these 
observations, the opinion appears to be concurrent, that much 
suffering, great increase of disease, and an augmented mortality, 
are the constant results. Let us then hear no more of the argu- 
ments derived from this class of people, in support of the unstable 
hypothesis, that the health of the children of the poor is a proof 
of the advantage of exposure to harden the body against cold, 
or to confirm the system against disease. 

456. We are aware that instances of the entire success of this 

1 It is here recommended not to mistake the meaning of this caution, and err 
on the contrary side : we do not mean to advise a directly contrary course ; for we 
are aware that many have fallen into this error, loading their children with un- 
necessary clothing, and absolutely keeping them sweating upon the least exercise, 
by an over cautious mode of sending them abroad. The children are then ex- 
posed to all the effects of cold air on a moist skin. 



OF FASHION. 125 

plan may be quoted against us: thus, that Mrs. A., B., C, &c, 
accustomed their children to such exposure; and it will be trium- 
phantly asked, " Where can you find finer or more healthy chil- 
dren?" But we would ask, in our turn, do they at the same 
time furnish us with an equally faithful list of those who have 
died from the experiment? If they could, the argument would 
not be urged a second time. 

457. The occasional success of a hazardous experiment is 
very often productive of the most serious evils ; it is followed as 
an example when it should have been regarded but as an excep- 
tion; nor is the error corrected, but at the expense oftentimes 
of many lives. Thus, for the supposed cure of an obstinate dis- 
ease by an ignorant quack, the patient, grateful for his recovery 7 
attributes to the skill of his attendant, and the virtue of his re- 
medies, what justly belongs to the strength of his own constitu- 
tion, or the favourable efforts of nature; and if they fail a hun- 
dred times in other instances, the disappointments are concealed \ 
for each is ashamed to declare he had reposed confidence in the 
remedies — therefore the supposed success is alone heard of. 

Sect. II. — Of Fashion. 

458. Fashion has also exerted a baneful influence over tbe 
best feelings of the mother, for she has become willing to sacri- 
fice the health and well being of her offspring at its shrine. 

The preposterous and unsightly exposure of the arms of chil- 
dren cannot be too loudly reprehended, since it has neither con- 
venience nor beauty to recommend it: but it is attended by the 
most serious and manifest injury to the child. This practice 
may be perpetuated from an ignorance of its dangerous ten- 
dency, and from a desire to give the body an increase of power 
to resist cold. We have in several places condemned the system 
of hardening, rather from the manner in which it is attempted, 
than from its want of utility, if properly conducted. In order, 
however, to render any plan effective, a knowledge of certain 
anatomical and physiological facts is essential; and we shall ac- 
cordingly expose them as opportunity may present itself, in the 
best manner we can. But upon no occasion, perhaps, shall we 
so satisfactorily have it in our power to show the injurious ef- 
fects of cold upon the chest and lungs, as in the custom we are 
now attempting to destroy. The cautions suggested by the ex- 
position we shall give will _be more valuable, as they will strike 
the common sense of every body; and they will be the better 
appreciated as the facts are the result of anatomical investiga- 
tion, and not deductions of preconceived theory. 

459. Portal, in a memoir inserted in "La Medicine Eclarte" 
p. 335, shows, with much clearness, the connexion between the 



126 OF EXPOSURE AND HARDENING. 

lungs and the superior extremities, by means of a great quantity 
of spongy cellular membrane, which proceeds from the upper 
parts of these organs; which, after passing under the clavicles, 1 
and accompanying the axillary vessels and nerves, 2 penetrates 
the glands of the arm-pits. The spaces between the scapula 3 
and the upper ribs are occupied by this tissue; so, also, is the 
space between the great pectoral and dorsal muscles, 4 under 
which it passes; and extends itself to other muscles of the 
back and those of the breast. The free and prompt communi- 
cation between the lungs and upper extremities is proved, M. 
Portal informs us, by injections. And nature may, in part, be 
imitated by the anatomist; for if he inject water into the cellular 
tissue of the lungs, it will be found to pass from air cell to air 
cell, until it arrives at the external part of the breast, and under 
the arm-pit ; from whence it spreads itself to the arms and late- 
ral parts of the chest, by means of the tissue just spoken of. M. 
Portal declares he has reversed this experiment by making water 
or air pass from the arms or arm-pits to the air cells of the 
lungs. From these facts the deductions are clear — namely, that 
whatever does injury to the upper parts of the arms or arm-pits 
will be felt by the lungs, &c. : hence the injury which must ne- 
cessarily arise from exposure of these parts to cold, &c. ; and 
hence, in a practical point of view, the importance of remedial 
means to these parts, in cases of disease of the lungs ; and hence, 
in children born of consumptive parents, the necessity and impor- 
tance of having them sufficiently protected from cold by suitable 
covering. 



Sect, III. — Of Exposure and "Hardening ." 

460. In our variable climate we oftentimes have every variety 
of the year in any one given portion of it ; thus, in the middle 
of our winter, we have sometimes the mutability of April or the 
mildness of May. If the latter be the case, or the temperature 
even lower, it would be folly to deny the enjoyment and advan- 
tages of fresh air, (the body being properly guarded,) because 
our almanac declares the month to be January. The rule, then, 
for taking children into the open air, either in summer or in 
winter, must be founded in some measure upon our sensations, 
and the thermometer; for in summer this instrument may indi- 
cate too high a temperature, and. in winter, one too low for the 
purposes of exercise or of exposure. 

461. But why should it be thought impossible to have fresh 
air in winter, unless the child be exposed to the inclemency of 

1 Collar bones. 2 Vessels and nerves of the arm-pits. 

* Shoulder blades and neck. 4 Muscles of the breast and back. 



OF EXPOSURE AND HARDENING. 127 

fin out door atmosphere? At that season of the year, is not the 
air in a well-constructed house of equal purity with that abroad? 
Cannot the temperature of a room be so regulated as to do away 
all risk in the enjoyment of the air? And is that air not suffi- 
ciently pure and elastic for all the purposes of health ? If these 
questions be answered in the affirmative, and we are sure every 
rational person will answer them so, we are in possession of a 
safe and certain means to give the child fresh air, without the 
serious risk of exposure. 

462. Let us, however, admit to the sticklers for exposure, 
there might be an advantage in "giving the child fresh air in 
cold weather." Agreeably to their opinions of fresh air, will it not 
be conceded, on the other hand, that it will require much care? 
Will it not require that the child's body, or other parts, should 
not be exposed, but carefully and sufficiently protected? Will 
it not also be admitted, that if attention be not paid to these 
circumstances, much risk, if not positive danger, will be in- 
curred? If these points be yielded, we will ask, if one mother 
in a hundred be so fortunate as to have a person to take the 
child "abroad" in which this essential confidence should be 
placed ? We are sure that many, perhaps, very many, will say, 
Yes ! because they believe so : yet any one of observation who 
traverses our city may contradict them; for they inay constantly 
witness the limbs of the little suiferer exposed until purple with 
cold, while the nurse is attentive alone to her ow^n pleasure or 
amusements, or holding a long gossiping colloquy with a dear 
friends whom she has not seen for the "age of a week," or in 
examining in detail all the attractions of a print-shop, or feasting 
her imagination with the delightful articles of a pastry cook's 
window. After this, the child is brought home, benumbed with 
cold: the mother receives it with rapture, and, because her dar- 
ling has been breathing an air but little above zero for several 
long hours, anticipates future health for her child, at the mo- 
ment, perhaps, it has received its death-wound. 

463. It may, perhaps, be urged in opposition to these opinions, 
that the children of poor people are constantly "exposed," and 
have, in consequence, the best possible health. But upon this 
point, let the whole truth be told: we admit that "the children 
of poor people are exposed;" and also agree that the number 
which remain of a family may even have "the best possible 
health;" but we would ask at what expense has this "best pos- 
sible health" been procured? Look at our bills of mortality, 
and see how large a proportion of the deaths is made up of young 
children; and then examine the returns at the Health Office, 
and you will find how many of these "exposed" little sufferers 
have died by the experiment, or, rather, perhaps, from the un- 
avoidable "exposure." 



128 OF EXPOSURE AND HARDENING. 

464. Many children, and especially those in large manufac- 
turing towns; those of poor people in crowded situations, and 
those who have but a scanty supply ef provisions, are born with 
a strong predisposition to diseases. In severe weather, they are 
exposed to the debilitating effects of cold, besides the evils just 
mentioned, by which the latent dispositions are converted into 
active diseases ; and these victims swell very much the bills of 
mortality. 

465. Cold, when combined with poverty, exerts an almost 
irresistible influence upon the human constitution; they destroy 
and spare not the helpless infant exposed to their violence; they 
desolate without stint or measure, and have more victims than 
any one disease in the whole catalogue of human maladies. 

466. Adam Smith confirms this, when he says, " It is not un- 
common, I have frequently been informed, in the highlands of 
Scotland, for a mother who has borne twenty children, not to 
have two alive. Several officers of great experience have told 
me, that, so far from recruiting their regiment, they have never 
been able to supply it with drums and fifes, from all the soldiers' 
children that were born in it." 1 

467. In thus attempting to point out the impropriety and 
danger of ill-regulated or indiscriminate "exposure," let us not 
be supposed to favour the opposite extreme — than which nothing 
can be farther from our views. We as earnestly deprecate an 
overweening caution, as we condemn unnecessary exposure ; the 
mean is the golden rule ; and the degree of temperature regu- 
lated by the force of constitution. It would be no less prepos- 
terous than injurious, to subject every child to an equal degree 
of exposure. The strength of constitution varies in almost every 
individual — cold air is, unquestionably, a cold bath with certain 
modifications ; now, no one would declare that the cold bath, and, 
especially, one of the same temperature, would be proper to 
every constitution, or at all times to the same constitution. 

468. We agree that children may be brought up too tenderly ; 
and we declare this mode to be as wrong as the other — because, 
like it, it has its victims. Extremes, therefore, are never right. 
Upon a subject like the present, it would be impossible to lay 
down precise rules for every variety of case — we, therefore, can 
only give general directions upon this subject; the deviations 
which particular instances may require must be left very much 
to the good sense and discretion of the parent. "We must re- 
mark, however, 1st, that the lungs of children cannot bear as low 
a temperature, with safety, as children of more advanced age, 
nor those of even a more advanced age so low a temperature as 
an adult; 2dly, that the injury which young children receive, 

'Wealth of Nations, vol. i. p. 105. 



OF EXPOSURE AND HARDENING. 129 

"when exposed to a very low temperature, is through the medium 
of the lungs, and is not of a direct kind ; for it generally re- 
quires the sudden application of warmth to call into action the 
injurious effects of the previous cold — therefore, this important 
caution suggests itself in the management of children who have 
been unavoidably or necessarily exposed to a low temperature — 
viz., not to bring them too suddenly into an atmosphere of high 
temperature; 3dly, as it is the lungs which especially suffer 
from a low temperature, no precaution of covering the body 
can protect them with certainty against the consequences of 
such exposure; yet, if the body be well protected, it will very 
much diminish the chance of injury to the lungs, by tending to 
maintain and equalize excitement; 4thly, but if both lungs and 
body be exposed, the system has then to contend against the 
depression consequent upon the exposure of a large surface of 
skin as well as that of the lungs; therefore, the risk of injury is 
increased from this circumstance. 

469. We once urged the above and similar objections against 
indiscriminate " exposure," to a lady who was a great stickler for 
it, when we were told, with an air of triumph, that the plan she 
had adopted in sending out her children would at once be an 
answer to all our objections to the practice. The plan, which 
shall be told in her own words, was as follows : — " When the 
weather is cold, and that is the time you principally object to a 
child being carried out, I take care not only to clothe the child 
very well, but, also, before the nurse sets out, to cover its little 
head completely with a good warm cloak, so that the cold air 
cannot get to its mouth; and it will sleep, when it is thus covered 
up, as soundly as if it were in its cradle in the nursery. So you 
see that no possible injury can happen to the child, since it is 
not made to breathe the cold air, which you appear so much to 
dread." 

470. We admitted this completely prevented the child from 
breathing the cold air; but it unfortunately created an objection 
nearly, if not altogether as strong, as the one it was intended 
to remove — namely, that it obliged the child to breathe a heated 
and impure air, generated by its own lungs ; consequently, the 
pretext for sending the child abroad was entirely done away. 
We asked this lady how she would like the plan of placing a 
child, on a very cold day, in the yard after carefully wrapping 
it up in its " crib," that it might enjoy a nap in the open air? 
This she declared would be highly dangerous, and she could never 
think of running such a risk. We then asked her in what this 
plan differed from her own? She became much puzzled for an 
answer, and could only defend it by saying that according to 
her method the child had the advantage of exercise, which the 
other had not. We then appealed to her candour, and asked if 

9 



130 OF EXPOSURE AND HARDENING. 

the child were more passive in the crib than while sleeping in 
the nurse's arms ? 

471. At another time, we were speaking with a lady who had 
lost three or four children with "croup," who informed us she 
was convinced, from absolute experiment, there was nothing like 
exposure to all kinds of weather, to protect and harden the sys- 
tem. By her first plan of managing her children, which was by 
keeping them very warmly clad, she lost several by the " croup," 
but since she had adopted the opposite scheme, her children had 
been perfectly healthy, and never had betrayed the slightest 
disposition to the terrible disease which had robbed her of her 
other children. 

472. " Perhaps, madam," we observed, " you did not, in making 
your first experiments, attend to a number of details, which might 
be thought essential to the plan — you probably did not take the 
proper precautions when you sent them into the cold air, or ob- 
served what was important when they returned from it." " Oh ! 
yes, I took every possible care ; when they were going out, I 
always made them wear a very warm great coat, well lined with 
baize, and a fur cap, or collar ; I always made them wear a 
'comfortable,' made of soft woollen yarn, round their necks; and 
their feet were always protected by socks or over-shoes, lined 
with fur or wool, as the weather might be wet or dry." 

473. "Do you believe, madam, they were kept at a proper 
degree of warmth by these means ? " " Oh ! certainly: indeed, 
rather too warm; for they would often be in a state of perspira- 
tion, they told me, when in the open air, especially when they 
ran, slid, or skated." "And what was done when they were 
thus heated?" " Oh! they got cool enough before they would 
get home." " And would they receive no injury in passing from 
this state of perspiration to that of chill?" "Not at all; for 
when this happened, I always made them take a little warm 
brandy, or wine and water, and made them ' toast' their feet 
well by the fire." 1 " Did they sleep in a cold or warm room?" 
"In a warm room; a good fire was always made in the stove 
before they went to bed, which kept them quite warm all night." 
" Would they never complain of being cold towards morning, 
when the stove had become cold?" "Yes, certainly; but then 
there were always additional bed-clothes at hand, with which 
they could cover themselves." " And did they always do so?" 
" Oh! I suppose so." 

474. " Well, madam, how do you carry your second plan into 
execution, which you say was attended with such happy results ? " 
" I began by not letting them put on their great coats, but when 
the weather was so cold as to require this additional covering, 

1 This absurd custom is a fruitful source of that distressing condition of the 
superior and inferior extremities, in winter, called " chilblains. " 



OF EXPOSURE AND HARDENING. 131 

and did not permit them to wear a ' comfortable ' or fur round 
their necks. I took away their over-shoes; and if their feet 
chanced to get wet, (for they were always provided with good 
sound shoes,) the shoes were immediately changed, if they were 
at home. If the weather was wet, or unusually cold, they were 
permitted to wear their great coats ; but not without. If they 
came home very cold, they were not allowed to approach the fire 
too soon. I gave them no warm, heating drinks, and accustomed 
them to sleep in rooms without fire." 

475. Who does not recognise in this second plan for the enjoy- 
ment of " air and exercise," as judicious a plan of " physical 
education," so far as it goes, as can be well pointed out? — one 
we have been endeavouring to recommend, instead of the one 
it purported to be, " the happy results of indiscriminate exposure, 
in all kinds of weather, to harden the system;" and in the first, 
a preposterous routine of mischievous observances ; observances 
entirely calculated to defeat the object for which they were so 
anxiously instituted. We were so successful as to convince this 
lady, in a very short time, that our "moderate plan" of ex- 
posing the body was precisely the one she had pursued with so 
much success. 

476. We also inquired .of this lady what plan she pursued 
with her children, when too young to be subjected to the rules 
just mentioned? She informed us it was the same system 
throughout, only the details varied, according as the circum- 
stances of age, &c, made it necessary — that is, she sent her 
children into the open air at very early periods of their lives, 
provided in summer it was neither too wet nor too warm ; in 
winter, when the air was mild, dry, and clear; but always care- 
fully wrapped up, that their little extremities might not suffer 
from cold. That she never suffered them to sleep in the open 
air, if it could be avoided; to prevent which, as much as possible, 
she constantly charged the nurse to bring the children home, as 
soon as she found them disposed to sleep, unless it was when the 
children were very young, at which time it was impossible to 
guard against it. 

477. And, when her children were sufficiently old to walk, she 
took care to provide them properly for it, whether it might be 
in warm, cold, or moderate weather. That she never sent them 
abroad for pleasure, at the risk of encountering a storm of any 
kind; nor permitted them to walk, at the hazard of getting wet, 
or very muddy feet. " Were the constitutions of your children 
pretty much the same?" we demanded of this lady. "No; one 
of my boys was extremely feeble, from his very birth." "Did 
you treat him after the same manner precisely as you did the 
others?" "Yes, as far as regarded principles — that is, I per- 
mitted him to bear as much of cold, heat, or wet, as his consti- 



132 OF EXPOSURE AND HARDENING. 

tuition would support without pain or injury; but the degrees 
were very different from those his brothers bore, had they been 
determined by the measurement of the thermometer, but pre- 
cisely the same in effect, as far as could be ascertained by conse- 
quences — thus, if he were exposed to the same temperature as 
his brothers, he experienced no more inconveniences from it, when 
it was very low, than they, because he had additional covering 
to protect him," &c. 

478. Let us not, however, be considered as advocates for a 
warm and enervating plan of education, because we condemn its 
opposite ; for we believe nothing contributes with more certainty 
to impair stamina, than too great a delicacy of treatment, espe- 
cially in the early part of childhood : and much as we deprecate 
ill-judged exposure, we are inclined to believe it is scarcely more 
injurious than over-stimulating the tender systems of infants, 
by means of injudiciously applied heat. Heat, beyond a certain 
degree, or when too long continued, even in an inferior degree, 
acts like any other stimulus upon the vibratile system of very 
young children. It over-stimulates the nervous, goads to ex- 
cessive action the circulatory, and relaxes the muscular systems. 
In consequence of this, the different parts of the body do not 
develop themselves in their most healthy order, or in their natural 
proportions — the whole body is urged to a precocious expansion. 

479. The cuticular system also suffers from this ill-managed 
application of heat ; on the external surface the sensible perspi- 
ration is greatly increased, and too long maintained ; by which 
means the sensibility of the skin becomes too much exalted, and 
cannot bear, without immediate inconvenience, a lower tempera- 
ture than that to which it has been for a long time accustomed ; 
hence, as soon as this part is exposed, there is an immediate 
check given to perspiration, by the capillaries terminating on the 
surface contracting themselves — disease is, of course, the con- 
sequence. 

480. It is not the external membranous system alone that 
suffers — the whole external arrangement of it is more or less 
affected; for they either act inordinately, and produce affections 
of the bowels or lungs, or they become torpid; and in this way 
invite disease, by the destruction or too great a diminution of 
certain important secretions. 

481. Children over-tenderly brought up, either by heaping 
upon them too much clothing, or prohibiting sufficient exercise 
in the open air, become liable to catarrhal affections, the instant 
"the winds of heaven a little too rudely visit them;" and this 
misfortune is instantly quoted against a proposal for a more 
invigorating plan of treatment. Thus, the effects of an impro- 
per system of education are mistaken for a natural weakness of 

in consequence of which, the error is perpetuated, 



OF EXPOSURE AND HARDENING. 133 

and the poor child becomes an early victim to a ferocious disease, 
or is made to drag out a protracted existence, in which there is 
neither comfort nor enjoyment. 

482. Such a plan of education is sure to entail imbecility of 
mind, as well as debility of body, upon its followers ; for every 
part is put not only too extensively, but too early, upon the stretch ; 
in consequence of which no organ is duly prepared for its offices ; 
and of course must perform its functions imperfectly. This hot- 
house plan of rearing children has ever had more victims than 
triumphs. It should, therefore, never be adopted, as it is con- 
trary to the dictates of reason, as well as to the results of ex- 
perience — and truly, like the hot-house plant, properly so called, 
is forced beyond its powers, and prematurely dies. 

483. One of the most remarkable instances of precocious ma- 
turity, is that^related of Louis II. King of Hungary. He was 
born so much before his time as to have no skin. 1 At two years 
old, he was crowned; in his tenth, he succeeded; in his four- 
teenth, he had a complete beard ; he married in his fifteenth ; 
he had gray hairs in his eighteenth, and in his twentieth died. 

484. But, though we unhesitatingly condemn the plan of edu- 
cation just spoken of, yet are we at a loss to understand why 
it should be considered so desirable to inure the body to extreme 
cold, in a climate like ours ; since the attempt must, in part, be 
defeated by every returning summer ; and more especially, as 
the experiment is often of great price, from the manner in which 
it is too often conducted by those who call themselves the exact 
followers of nature. In climates where cold is in the extreme, 
nature attempts to guard against its evils by established laws, 
and not by occasional or desultory experiment. In the very 
high latitudes, the inhabitants are enabled to support the low 
temperature to which they are exposed, by a physical conforma- 
tion peculiar to such climates — thus, they are almost invariably 
short of stature, fat, and enormous eaters of the most stimula- 
ting food. 

485. Their short stature enables the heart to drive the blood 
with more force and certainty to the extremities; and these are 
the parts most likely to suffer; for it is almost invariably found, 
even in our comparatively warm climate, that tall people suffer 
more than short, from cold. And, hence it is, that the face, col- 
lectively, is enabled to support cold better than the hands, or 
feet, as it is nearer the source of circulation; and not because 
it is more accustomed to cold from exposure : for certain parts 
of it, (if we may so unite them,) as the ears, and the extremity 
of the nose, in which the circulation is more languid, suffer 

1 This only means, we presume, that this covering to the body was exces- 
sively delicate, as we always witness when the foetus has not reached the seventh 
month. 



134 OF FOOD. 

equally with the more remote parts of the body. The fat of 
people of high latitudes also tends to the same advantage ; it is 
a bad conductor of heat, and thus serves to prevent its escape 
when generated within the system; while their rapid digestion of 
the most stimulating substances favours the extrication of ca- 
loric. 

486. Both reason and experience, then, seem to caution us 
against adopting with too much rigour a system which is by far 
too general in its principles, for useful or healthful application ; 
but they at the same time direct us to conform to one, which 
shall permit departures, whenever such departures shall be war- 
ranted by a change of circumstance, or rational expediency. 
And hence, we may conclude that there can be nothing more 
dangerous than the random application of principles that are 
in themselves doubtful. 



CHAPTER III. 

OF FOOD. 

487. The necessity of food commences after the first few 
hours of a child's birth ; hence the early provision that is made 
by the mother's breasts. Of this we have already spoken at 
some length, and laid down some important general rules, which 
we do not think necessary to repeat here. When we were upon 
this subject we considered the mother as the only proper provider 
for the child; and we decided that it was her duty, and hers 
alone, to provide it nourishment from her own bosom ; and, the 
more effectually to insure this under the best circumstances, we 
recommended the early application of the child to the breast, 
and gave our reasons for these directions. In addition, however, 
to what we then said, we shall give some other important reasons 
for such advice. 

488. In the last paragraph we have in a very positive manner 
declared it to be the duty of the mother, and of the mother alone, 
to provide sustenance for the child, and that from her own bo- 
som — this is our decided and unalterable opinion, as a general 
rule; a rule that should not be heedlessly or unnecessarily 
broken; one that should not be infringed, but from an imperious 
necessity. No plea of inconvenience or trouble ; nor the sub- 
terfuge of imagined ill health, either immediate or remote, should 
be held valid. The incapacity, or incompatibility, should be 
positive, ere the exception to the rule should be admitted; never- 
theless, disqualifications may, and really do exist sometimes, as 
we shall now attempt to show. 



OF FOOD. 135 

Sect. I. — Causes ivhich may render it improper for the mother 

to nurse. 

489. The 1st is, where there is no provision made for nou- 
rishing the child; or where this is not in sufficient quantity, 
either owing to a natural or accidental derangement of the 
breasts, or the imperfect performance of their duty. 

490. 2dly. Where the supply may be sufficiently abundant in 
the commencement, but where it habitually fails in a short period 
after, owing to some constitutional or accidental defect, which, 
perhaps, is neither evident nor remediable. 

491. 3dly. Where, upon former occasions, it was unques- 
tionably found to disagree with the child. 1 

492. 4thly. Where there is a strong venereal or scrofulous 
taint in the constitution of the mother. 

493. 5thly. Where suckling produces an active or painful dis- 
ease in the mother, as cough, colic, &c. 

494. 6thly. Dr. Struve says, "Those mothers who are so un- 
fortunately situated that they cannot avoid provocation, grief, or 
sorrow; as well as others, who possess an irascible and bilious 
temperament, or are subject to great nervous debility, accom- 
panied by a great susceptibility of every stimulus, will confer no 
benefits on their children by presenting them with a corrupted 
milk, which cannot fail to injure their health, and lay the foun- 
dation for consumptive and fatal maladies." 2 It must not, how- 
ever, be imagined, that we intend to convey the idea by this quo- 
tation, that the milk itself contains the rudiments or seeds of 
the diseases just mentioned, but merely that constitutions la- 
bouring under such infirmities, cannot furnish healthy milk, or 
that of a sufficiently nutritive quality; and in consequence of 
the child being imperfectly nourished, its constitution yields to 
its predispositions, and active disease is produced. 

495. Parents labouring under certain chronic affections may 
transmit to their offspring predispositions to such diseases; and 
the body so predisposed, if it be not properly nourished in its 
very early infancy, whereby it may become strong and well de- 
veloped, the constitutional tendency may be called into action, 
and the child die early, or have a protracted disease as its con- 
sequence. These cases are daily presenting themselves to the 
physician, for his contemplation ; and they have long and anxious- 
ly engaged his most serious consideration ; the result of which, so 

1 We must not, however, take this rule without exception — we have seen two 
instances within the last few years,.where the mothers upon former occasions were 
obliged at an early period to abandon suckling, owing to the bad qualities of their 
milk; but upon the occasions now spoken of, it was not only very abundant, but 
of most excellent quality. The children, in both these instances, were of uncom- 
mon health and vigour. 

3 Treatise on Physical Education, p. 215. 



136 OF THE MECONIUM. 

far as experience has yet determined, is, that nothing gives so 
effectual a check to this tendency as bringing up the child upon 
a healthy breast of milk. 

496. Therefore, when either of these conditions of the parent 
obtain, either in the shape of infirmity of temper, or of actual 
disease, it is certainly proper to provide the child with some other 
means for support, but the precise mode must be determined by 
circumstances : the best for such cases as the fourth, (492) and 
the sixth, (494) is a healthy wet nurse, especially in the country. 



CHAPTER IV. 



497. During pregnancy there is an accumulation of a dark 
green substance in the bowels of the child, which is called " me- 
conium," from its supposed resemblance to the syrup of poppies. 
This substance contains some bile: 1 it is in various quantities; it 
is of different tones of colour, and of degrees of tenacity ; and 
when permitted to remain undisturbed in the bowels of the child, 
is productive oftentimes of much mischief, especially in hot cli- 
mates. This being the fact, it now seems to be admitted by 
all who are conversant with this subject, that it should be 
purged off as early as circumstances will permit. It is only 
wonderful that there should have been two opinions upon this 
subject; since nature, if properly followed, performs this office 
by her own means, without the interposition of art. She effects 
this important end by means of a substance found in the mother's 
breasts, upon the first application of the child to them, called 
colostrum. 

498. But to derive advantage from this natural purgative, the 
child, as we have before remarked, must be applied early to the 
breast : if this be neglected until the secretion of milk, properly 
so called, takes place, it becomes too much diluted to serve this 
important end, and we are then under the necessity of having 
recourse to artificial purgatives, which never remove this sub- 
stance so kindly as the colostrum. 2 Hence in consequence of 

1 The meconium is evidently excrementitious, as it only occupies the colon and 
rectum : that it generally contains bile is every way certain, but not necessarily, 
as, in some instances, bile has not been found in the duodenum of still-born chil- 
dren that had arrived at full time, though meconium was present. 

2 It may be remarked, that those children who have been kept from the breast 
for several of the first days after birth, because, as the ignorant nurse declares, 
" there is nothing for them to draw," are uniformly more difficult to " cleanse," 



OF THE MECONIUM. 137 

this neglect, the child is often tortured by colic or spasm, from 
the harsh remedy -which may have been employed for this pur- 
pose. 

499. Purging off the meconium is a matter of more importance 
than is generally supposed, as well as the manner of doing it. 
The propriety of this measure is so universally acknowledged in 
this country, that it has become a practice of routine in the 
management of new-born children; and in becoming so, it is made 
a matter of too much indifference by what agent this is produced 
— hence the improper employment of stimulating and drastic 
purgatives upon such occasions, to the decided inconvenience, 
if not to the manifest injury, of the child. This disregard of the 
means by which the meconium is carried off has arisen some- 
times from an over-importance being attached to the conse- 
quences, should it be suffered to remain, or be found difficult to 
remove. 

500. Should this substance have been but imperfectly dis- 
charged from the bowels, all the evils which may chance to assail 
the child are attributed to this neglect — nurses, accordingly, 
dreading such an accident, take care that no such blame shall 
attach to them ; they, therefore, become indifferent to the means 
for its removal, provided the end be answered. In consequence, 
harsh and ill-judged remedies are employed; and, sometimes, to 
the almost immediate destruction of the child. We are per- 
suaded, from our own observations, that many instances of the 
severe and sometimes fatal bowel complaints of very young chil- 
dren, have arisen from no other source ; and it, therefore, be- 
comes an important part of our duty to inveigh against this dan- 
gerous practice. 

501. The evil we are now speaking of has principally arisen 
from two sources — 1st, as has already been remarked, from an 
undue importance being attached to the retention of the meconi- 
um : and, 2dly, from too unlimited a confidence being placed in 
the judgment of the nurse. As regards the first, we hold it highly 
proper, nay, perhaps, essential, that the meconium be carried 
off; because nature herself declares its propriety ; but it by no 
means follows that this must be effected, coute qui coute, — the 
means should be properly adapted to the end ; and of these we 
have a sufficient choice. For the purpose just suggested, a 
solution of molasses, or of manna, in a little warm water ; a tea- 
spoonful of sweet oil; the same quantity of the simple syrup of 
rhubarb; or, in more obstinate cases, a tea-spoonful of warm 
castor oil, is almost always sufficient. 

502. It is true that we occasionally meet with instances of 

than those who have received into their stomachs the " colostrum" just spoken 
of. This substance, however, may be aided by the exhibition of a little molasses 
and water. 



138 OF THE MECONIUM. 

such tardiness of bowel, or so large a quantity of meconium, that 
a repetition of the above named remedies may be necessary; but 
they should never be persevered in after the object for which 
they were given has been answered ; and this is ascertained with 
almost absolute certainty by making ourselves acquainted with 
the appearance of the evacuations — if they are no longer tena- 
cious, and of a dark green colour, the bowels have been suffi- 
ciently purged, or, in other words, if the evacuations have be- 
come yellow. 

503. 2dly, Much mischief has been done by reposing too much 
confidence in the judgment of the nurse. This always conveni- 
ent, and oftentimes highly valuable appendage to the lying-in 
room, is too frequently self-willed, and will too often run counter 
to the advice of the physician. This arises from her attaching 
too much consequence to her own experience, or by having "the 
pride of office " in her opinion too much humbled by an appeal 
from her decisions. To prevent her self-love being wounded by 
interference in her management, she very often conceals from the 
physician in attendance any casualty that may befall the child; 
and thus important time is sometimes lost, for the complaint 
may be serious when the physician is first made acquainted with 
it: whereas, had it been attended to with sufficient promptitude, 
it might have been of little moment: here, by her want of know- 
ledge of what was proper to be done, and the application of im- 
proper remedies, the disease has been permitted to acquire a 
force that may bid defiance to all future attempts at control. 

504. We trust we have a just and due respect for this class of 
people ; and we are sure we are incapable of bringing any false 
charges against them ; but a long experience has settled in our 
minds their exact value. The estimate we have made of their 
worth makes us declare that some are invaluable for their patient 
endurance of fatigue ; for their occasionally successful exercise 
of judgment; and for an amiable display of social virtues; but 
others are the very reverse of what we have just declared. 

505. During the attendance of the physician, the duty of a 
nurse, as regards the medical treatment of both mother and child, 
is reduced to great simplicity — for she should but obey, and that 
implicitly, his directions. She should never violate his orders 
herself, nor knowingly suffer others to do so; but every thing 
which belongs to medical treatment, whether it be merely pro- 
phylactic; the absolute administration of medicine; or the ob- 
servance of regimen, she should never interfere with; on the 
contrary, she should most scrupulously see them duly and rigor- 
ously enforced; for it is her bounden duty. During the period 
of convalescence, she should constantly make her directions and 
management conform to the general principles inculcated by the 
medical attendant. When she does more or less than this, she 



OF THE MECONIUM. 139 

does wrong, and ought to be made accountable for any mischief 
that may happen. But we have, perhaps, no right to expect any 
thing but the exercise of the blindest temerity from those whose 
opportunities do not afford intellectual culture. 

506. Unfortunately, the custom of society is, in this particular, 
almost in direct opposition to what we esteem its best interests. 
The opinion of a nurse is oftentimes taken before that of an ex- 
perienced practitioner ! In this the world departs from all its 
other habits. If advice be wanted on a question of law, will it 
prefer the opinion of the constable to that of the experienced ad- 
vocate? If a text of scripture is wished to be expounded, will 
it apply to the church clerk, rather than to the learned divine? 
Or, should even a coat, or hat, or a pair of shoes be wanted, will 
it prefer the efforts of the apprentice to those of the master? 

507. If this practice had not a decided influence upon the im- 
mediate health, or the future welfare of the child, we should not 
think it worth mentioning; but when we have witnessed so many 
serious errors committed at this period of the child's life, we 
think it an imperious duty to try to correct them. In making 
these charges against this class of highly necessary people, we 
disclaim all intention to criminate — we urge but an error of judg- 
ment. But from the number of victims, as we most conscien- 
tiously believe, this confidence in nurses has had, it is full time 
a stop were put to their ravages : for, were we to declare honestly, 
in round numbers, the instances of death of very young chil- 
dren, which we believe we have witnessed ourselves, in conse- 
quence of the errors we are speaking of, we should be afraid our 
truth might be questioned, and that we should be suspected of 
indulging in hyperbole. 

508. Nor will this statement excite much surprise, when the 
facts connected with it shall be investigated by rational and dis- 
passionate inquiry. Let it be remembered by what a tender 
tenure a new-born babe holds its ill-established life; let it be 
recollected how many causes may suddenly act to weaken that 
life, which is now so frail; let it be taken into view that if these 
causes be not successfully removed they, for the most part, will 
produce death ; then let it be admitted how much judgment and 
experience are required, to detect the particular cause; how 
much care and knowledge are essential to the suiting of the 
strength of the remedy to the force of the disease ; and let it be 
acknowledged that if these do not unite in the person of the 
nurse, who now usurps the place of the physician, that much 
danger must be incurred, and we shall cease to wonder that 
their efforts, to say the least, are not crowned by success. 

509. It is our firm conviction that the mortality among chil- 
dren is unnecessarily great; and that this excess originates, in 
very many instances, in the mal-administration of the means of 



140 OF THE MECONIUM. 

life, rather than to the operation of natural or inevitable causes. 
Some are nursed to death, while many die because they are not 
nursed at all; some are fed to death, while others die from ina- 
nition ; some are physicked to death, while others die from the 
want of a single dose of it — all of which go to prove how much 
experience and judgment are required to administer with success 
to the many wants and infirmities of children. 

510. It must appear reasonable to every reflecting mind, that 
the great mortality among children must have for its cause a 
variety of circumstances, not absolutely essential ; and that it is 
more than probable that many of the contingencies to which the 
poorer classes of children may be subjected, are of a nature to 
be improved, if not to be removed altogether. It justly merits 
the consideration of every friend to humanity, to ascertain the 
causes which may produce this uncommon mortality, with all the 
precision of which the subject may be susceptible. 

511. To us short-sighted mortals, it would seem to be no part 
of God's providence to create so many children that they may 
perish at so early a period of their existence. And we are firmly 
persuaded that the following are the principal means by which 
this immense mortality of children may be diminished: — 1st, 
Let none but a mother, when she is able, have the immediate 
charge of her child ; for she alone should supply it with food ; it 
is she alone who should administer its medicine. 2dly, Let 
every mother make herself well acquainted with the best opinions 
upon the physical management of children ; but never let her 
aspire to their medical treatment, except from dire necessity. 
3dly, Let no mother trust another to count out doses of lauda- 
num, while she herself retains the faculty to do so, unless the 
person thus chosen has as deep or nearly as deep an interest in 
the child as the mother herself. 1 4thly, in a case of indisposition, 

'We have italicized this direction, because of its importance, and because we 
wish it to be impressive: for we have every reason to believe that the trusting this 
important office to others, has been fatal in several interesting cases, which have 
fallen under our immediate observation, and, in several, we have had proof, while 
in others, strong suspicions were entertained that the deaths were owing to the 
improper exhibition of laudanum. This drug has now become so familiar as to 
be ranked with the " domestic remedies :" its presence no longer excites dread, 
nor its exhibition terror. But let it be remembered that, however the horror of 
the rattlesnake may be diminished by familiarity, its sting is no less deadly. 

We have every reason to believe that thousands of children are sacrificed yearly, 
by over-doses of this medicine. Its use is so common, and its virtues so often 
witnessed, that caution sleeps — for even children are trusted with its exhibition. 
A fatal instance of this kind has happened within our knowledge, not long since. 
A fine little girl of nine years of age, complained to her mother of the toothache — 
the mother told her to put some laudanum in it, and gave her a vial of the liquid 
for this purpose. The child took a quantity of it into her mouth, and held it 
there ; but at the same time swallowed enough to destroy her in a few hours 
after. And we once heard a mother, who was about to leave home for some hours, 
desire her daughter, a girl of eleven years of age, to give the baby five drops of 
laudanum, should it be "cross" while she was gone! We remonstrated with 



OF THE PROPER NOURISHMENT. 141 

let the mother confide in no judgment for her child's disease, hut 
that of her physician, if his advice can be commanded, and, above 
all, let not his prescription be interfered with by the obtrusive 
advice of a nurse, or still more ignorant old woman. 5thly, Let 
a mother place no undue confidence in the prescriptions of a 
nurse, under the persuasion that her experience must be valua- 
ble, when the advice of an experienced physician can be obtained ; 
for let it be recollected, that if experience is to be the guide, the 
latter sees a hundred patients, to one of the former. If these 
simple rules be well observed, we are persuaded they will tend 
to abridge the mortality among children. 

512. Let us also call to our recollection a truth, which we be- 
lieve none will dispute — that, in general, children are born 
healthy, and with good stamina; and, with the exception of purg- 
ing off the meconium, they require no medicine. If this become 
necessary, it is no infringement of the rule — it is but the excep- 
tion to it; therefore, the vile and hurtful practice of drugging 
young children cannot be too much reprehended. 



CHAPTER V. 

OP THE PROPER NOURISHMENT FOR THE CHILD. 

513. Nourishment, and this derived, if possible, from the 
mother, is all that a new-born child requires ; and it does not 
happen, once in a hundred times, that the mother is not in every 
respect competent to this end ; especially if she have previously 
discharged the duties of one, by paying a proper attention to 
her health. It rarely happens that the child does not find more 
than is absolutely necessary to its sustenance ; therefore^ it were 
preposterous to furnish it with more. 

514. The reasons which are assigned, for giving the child 
other nourishment than the mother's milk, may be divided into 
the relative and the absolute. The relative are — 1st, the fear 
of weakening the mother ; and, 2dly, convenience. The absolute 
is, the mother not furnishing a sufficient quantity, or thai of 
proper quality. It is, therefore, said, first, that the child should 
be fed to spare the mother ? How spare the mother? If she 

her upon this extreme carelessness, but we were answered, her " daughter was 
used to it!" 

It is still fresh within our recollection, when our prescriptions for laudanum 
would frequently meet with opposition; and if the counting of it were trusted to 
the "nurse," she would, perhaps, diminish the dose — but now ! she gives it not 
only with a free, but oftentimes with a daring hand. A laudanum bottle is now 
a sine qua non to the furniture of a nurse's pocket. 



142 OF THE PROPER NOURISHMENT. 

furnish more than the child can consume, or only as much, how 
is the mother spared by satisfying the child's appetite by other 
means? The milk is secreted in the breasts by taking so much 
material from the general mass of blood ; and all the consequen- 
ces which can happen by that deduction, are already experienced 
in its formation. Therefore, the woman is no more weakened by 
the child's taking it from the breasts, than if it remained in them 
to be absorbed from them ; or, in other words, the woman will not 
be strengthened by permitting it to remain undisturbed in them. 

515. 2dly, Convenience. It is said the child should be fed 
early, that it may become accustomed to it, in case the mother 
should be sick, or should wish to go out, or to leave it upon any 
occasion. But we say, " Sufficient for the day is the evil there- 
of" — and that the child should never be subjected to a certain 
evil, to guard against a contingent one; for should the mother 
be ill, and suffer a diminution of milk, the child can then be 
taught to feed as certainly, when feeding may be useful, as when 
it is not required. Therefore, there is nothing gained by the 
anticipation ; but there may be something lost. And, considered 
as a convenience, when the mother may wish to leave her child, 
it is both a cruel and unnecessary one — cruel, because it will 
tempt a gossiping mother to neglect her dependent child; and 
unnecessary, because a child that is governed by a well regulated 
system of nursing can never suffer by any proper period of ab- 
sence of the mother. 

516. It should, however, be observed, that the child should 
not be subjected to any laws of nursing until it is six months 
old; for up to this period it will be rarely necessary to establish 
a system, as it will seldom make unnecessary demands for nou- 
rishment, unless a bad one have been pursued from the com- 
mencement, by indulging, or rather attempting to quiet the child 
by the breast, or by the still more improper plan of giving it 
pap, because it cries. If this system be pursued, much inconve- 
nience will result; for one of two things must happen: 1st, If 
the child do not cry from absolute pain, a bad habit will be 
generated; for the child will cry for the mere gratification of 
being nursed; this will not only create a great deal of trouble, 
but will be highly injurious to the stomach itself, by occasioning 
it to be overloaded, and thus producing vomiting, purging, or 
colic; or, 2dly, If the child cry from actual suffering, the food 
may not do any possible good, or it may much increase the evil, 
by its being given at an improper or unnecessary time. There- 
fore, before this kind of indulgence is established, let the mother 
believe the child may cry from other causes than hunger, espe- 
cially if the breast or food have not appeased it — let her examine 
whether a deranged, or ill- adjusted pin, may not create the pain ; 
or that its bowels may not be tormented by flatulency: in the 



OF NURSING BY THE MOTHER. 143 

one case it is evident that the feeding can do no good; and in 
the other it may be mischievous. 

517. We all know how easily the stomach may be made to 
demand more food than is absolutely required — 1st. by the fre- 
quent repetition of aliment, or 2dly, by its variety ; therefore, 
both of these causes must be avoided. The stomach, like every 
other part, can, and unfortunately does, acquire habits highly 
injurious to itself — and that of demanding an unnecessary quan- 
tity of aliment is not one of the least. It should, therefore, be 
constantly borne in mind, that it is not the quantity of food 
taken into the stomach that is available to the proper purposes 
of the system ; but the quantity which can be digested, and 
converted into nourishment, fit to be applied to such purposes. 

518. After the child has attained the sixth month, some 
system should be observed in all its little supplies, whether of 
nursing, or receiving of food, of rest, of cleaning, or of exercise ; 
and as life really consists but in the performance of a routine 
of habits, it is a matter of much moment that only such should 
be established as will most effectually serve the general and best 
purposes of the system — therefore, all unnecessary, as well as 
every improper one, should be avoided ; consequently, the sooner 
we begin, and the more regularly we adopt such as are proper, 
the better. 

519. On this account, as little variety in the food of the child 
should be permitted as possible; for when many substances 
are offered, the stomach will receive more than it can master; 
precisely like the adult at a plentiful table, each new article 
becoming a fresh provocative to appetite ; and for this reason, 
also, a little latitude should be given to the periods of sleeping 
or feeding; for though we distinctly perceive an advantage in 
some established order for these, yet this order should not be 
rigidly established, to the moment; for when it is strictly ob- 
served the child will require both the one and the other from 
habit, rather than from necessity. Therefore, this extreme 
regularity must be avoided, as much inconvenience may other- 
wise result to both mother and child. 



I 



CHAPTER VL 

OF PARTIAL, ARTIFICIAL NURSING. 

520. The absolute reason for feeding the child, namely, the 
mother not furnishing a sufficient or a healthy supply, is the 
only one which should be considered as obligatory. Such cases, 



144 OF NURSING BY THE MOTHER. 

however, present a choice of means — 1st, where the mother may 
continue to suckle her child, aided by artificial means ; 2dly, 
where she is obliged to have recourse to artificial means entirely ; 
3dly, a wet nurse. 

Sect. I. — First means ; or where the Mother may continue to 
nurse her Child. 

521. We have always considered it best, when there is such 
a reduction of the mother's milk, as but imperfectly to nourish 
the child, to aid this scanty supply with the preparation we have 
already noticed, (248,) consisting of cow's milk, water and sugar. 
This may be administered to the child in one of two ways — 1st, 
by the spoon ; and, 2dly, by the bottle. "We should, however, 
never recommend the first if the second can be enforced; and 
for the following reasons: 1st, it is always less clearly, as the 
child's breast is almost always wetted in the attempt; 2dly, 
the child is always fed lying down, and, consequently, there 
is some risk of strangulation ; 3dly, the temperature of the fluid 
about to be administered may be so high as to do injury to the 
child's mouth and throat, by burning ; 4thly, there is a constant 
temptation to improve the victuals, by the addition of flour, &c. ; 
5thly, by the food being previously made to pass through the 
mouth of the nurse, before the child receives it; 6thly by this 
method the child loses the advantage of the admixture of its 
saliva with the food it is receiving. Therefore we consider the 
second plan to be the best, when it can be adopted. 

522. It may be asked, would we confine the child, which is 
in part artificially nourished, to the diet just mentioned, until 
the period of weaning ? We would say, No — we would permit 
the addition of barley water, of gum Arabic water, of rice water, 
or a small portion of arrow root, after the fifth month, 1 in cool 
weather, should there be a predilection in their favour; but, up 
to this period, and in hot weather, we believe the simple diet, 
above mentioned, to be the most proper; especially as the sto- 
mach gets a habit, if we may so term it, of digesting articles 
with ease by becoming familiar with them ; hence the propriety 
and importance of confining the child to the mother's milk, 
whenever this is practicable. 

523. Dr. Clarke very justly observes that "nothing is more 
absurd than the notion that in early life children require a variety 
of food : only one food is prepared by nature for them, and it is 
too presumptuous to assume that the Creator of the world acted 
in error ; and that the ignorance of man is capable to correct it, 
or make any improvement in his works." 2 

1 We are always supposed, in our directions, to have reference to children in 
good health: the medical treatment of them is a distinct consideration. 

2 Commentaries, p. 53. 



OF NURSING BY THE MOTHER. 145 

524. The articles of food administered to the child by the 
artificial plan should be as little varied as possible, for the reason 
just stated, and, also, because each article has its period for 
digestion ; it will, therefore, follow, that some may be of such 
difficult solution as to be productive of much mischief. Much 
care is also required to preserve the artificial articles in a per- 
fect state, as we have already noticed; and the directions given 
at that time should be strictly adhered to, that the stomach may 
receive nothing in an altered or partly decomposed state. Be- 
sides, is it not folly to change that substance which agrees per- 
fectly well with the child ? 

525. Indeed, nature has very emphatically declared, by the 
organization of the infant, that her laws respecting food cannot 
be transgressed without marked injury. The want of teeth, or 
the means to masticate, and the feebleness of the powers of di- 
gestion, in early infancy, strongly indicate the necessity of an 
especial regard being paid to the food of the child, to preserve 
it even in common health, and to prevent the development of 
several painful and fatal diseases. Therefore, it has always 
been found decidedly injurious, if not immediately fatal, to an- 
ticipate the powers of the stomach, by offering food to it, which 
was beyond its capacity to digest — hence, the frequent develop- 
ment of consumption, scrofula, and rickets, at an early period of 
life in the children of the poor, because food suitable to the 
ages of children could not be procured \ or, in others, from the 
disregard of a truth so obvious as, that a child of a few days or 
even months old, cannot digest the food that may be proper for 
children of a much more advanced period. 

526. From the earliest period of medical history, the impor- 
tance of this rule has been insisted on: for Hippocrates himself 
inculcated its necessity, and strongly insisted upon its impor- 
tance, and devoted a considerable part of his works to the sub- 
ject of diet; nor have his cautions or instructions upon this 
point ever been disputed. Therefore, a deviation from the rule 
— namely, to accommodate the nature of the food to the age 
and powers of the child, should only be infringed from necessity. 

527. Nature has ever been attentive to this subject, through- 
out animal existence; she has governed the general system al- 
most exclusively by the powers of the stomach; and we may 
trace the influence of this law from the simple hydatid to the 
most perfect animal. She has so arranged the powers of tbe 
stomach that a departure from the general law which governs it 
cannot be made without evident injury and perhaps death itself. 
Thus, the cow cannot be made to live upon animal food, nor the 
tiger upon vegetables, &c. The same general rule holds good 
with regard to man in the early and after part of his existence. 
It will be agreed upon by all, that the infant could not be made 



146 OF NURSING BY THE MOTHER. 

to thrive upon the gross food necessary to adult age; and that 
adult age would be but ill-sustained by the food of early infancy, 
however abundant it might be in quantity. And the same 
principle holds good in the whole class of mammalia. For in 
this class, milk is always the first article prepared for the sus- 
tenance of the young of every species ; and they are confined to 
it universally until fitted by a new arrangement of organization 
to profit by other food. 

528. The law is more remarkable with man, perhaps, than 
with any other animal; for the state of probation, if we may so 
term it, is no longer with him than any other. The early parts 
of his life are marked by most important and distinct periods ; 
and each period has its appropriate state of mouth, and powers 
of stomach: thus, before the appearance of teeth, nothing can 
be proper but the milk of the mother; after the appearance of 
some teeth, the addition of some farinaceous substance may be 
permitted ; and after their completion, or even a little earlier, 
animal substance may be added. 

529. It is often asked, at what age will it be proper to make 
a change in the diet of the child, by giving it a proportion of 
animal food? This question must be answered by referring to 
a principle, and not to a period of the child's life, marked by a 
lapse of any number of months. Nature has declared by the for- 
mation of the teeth, and by the organization of the stomach, that 
man is a promiscuous feeder; and that a due mixture of vege- 
table and animal matter is essential to his best and most perfect 
well-being. The question now narrows itself, by asking, by what 
sign it shall be known when a change of food can advantageously 
be introduced into the human stomach ? This is fully answered, 
we trust, above. If the cutting of teeth shall mark the proper 
period for changes, (as we believe it does) it will at once be seen 
it cannot be fixed by dates ; since the cutting employs from the 
third to the eighteenth month or sometimes even longer. 1 And 
it would seem to follow, from these premises, that animal food 
cannot be given with propriety, even in small portions, to a child 
before the system has protruded the grinding teeth; therefore, 
we would say, as a general rule, it would be improper before that 
event has taken place. 

530. After a child has got its grinding teeth, its food may be 
a little more varied, as well as more substantial; yet it must 
consist principally of milk, in which grated cracker may be 
stirred; well baked stale bread; rice flour, or arrow root; and, 
occasionally, a little animal food hi substance may be given, 
provided it be previously well divided; or it may be used in the 
form of broth or tea. After the eye and stomach teeth have 

1 We have, at this moment, (May 1825,) a little patient seventeen months old 
who has not cut a tooth. 



OP NURSING BY THE MOTHER. 147 

come through, the child may be indulged daily, but only once a 
day, with solid animal food, which has been either boiled or 
roasted; as any other mode of cooking it is exceptionable. 

531. An error is constantly committed, in the early exhibition 
of animal food — it is imagined that all kinds are equally proper, 
and these either salted or fresh. And farther — if the child hap- 
pens to be reduced by any cause, they suppose that, the more 
frequently meat be given, the more the child will be benefited. 
But such people should be made to understand that it is only 
that part which is digested that can be useful, and that this will 
depend exclusively upon the powers of the stomach, and, more- 
over, that these powers can be easily over-strained. And, in 
corroboration of what we have just stated, it is agreeable to all 
observation that the healthiest children are those that eat the 
least animal food. 

532. Though the occasional and moderate employment of 
animal food may be sometimes necessary from peculiar circum- 
stances after some teeth may have made their appearance, yet 
the quantity, and quality, are not matters of indifference. It 
should never be given in such quantity, in a solid form, as to 
make it a meal, as the stomach, most probably, will be unable 
to manage so great a bulk; and certain it is, the existence of 
the system cannot require it. The most proper mode to exhibit 
it is in the fluid form — such as beef, mutton, or chicken tea, 
without any mixture of vegetable juices. These teas should be 
given at such intervals and in such quantities as the deficiency 
of the mother's milk, or the situation of the child, may render 
necessary ; or as a change of food may be judged important, 
from the number of teeth ; or when the advancement of the age 
of the child may seem to require this additional stimulus, without 
such a failure on the part of the mother. 

533. It is not a matter of indifference what animal is made 
choice of for its flesh — some are decidedly better than others. 
Beef, mutton, or fowl, are much to be preferred to veal, lamb, or 
pork. Oysters are very unexceptionable articles of diet, when 
made into a thin soup. In using, however, any of these articles, 
especially in warm weather, care should be taken to have them 
fresh; as any progress towards decomposition would be highly 
improper, if not really dangerous. Therefore, but small quan- 
tities should be prepared at a time, and used as quickly as may 
be, after. The lean parts of either of the first named meats 
should be used in making a tea, or, if it be difficult to separate 
the fat before boiling it, it is not so afterwards; for if the pro- 
duct be permitted to cool, the greasy portion can easily be sepa- 
rated. The red juice which flows upon the cutting of under-done 
beef, or mutton, can very advantageously be employed, by add- 
ing an equal measure of water, and suffering it to boil — there 



148 OF NURSING BY THE MOTHER. 

should always be a little salt added, and a blade of mace is a 
pleasant and proper addition, especially in hot weather. Veal 
or lamb may be used, provided the beef, mutton, fowl, or oysters, 1 
cannot be procured: they must, however, always be looked upon 
as inferior to the others. Pork is never admissible. 

534. Regular periods, or nearly so, should be observed in ex- 
hibiting the animal juices, that they need not interfere with the 
digestion of the milk the child receives from the mother ; there- 
fore, it will always be best to give them at stated times, taking 
care to let it be received upon an empty, or nearly an empty 
stomach; especially when this change is commencing. The 
reason for this is, to insure to the newly introduced substance 
the full powers of the stomach. 

535. On this account, it is also right that the mother observe, 
after a certain time, some regulations as regards the periods for 
suckling — we have elsewhere fixed the period at about the sixth 
month, (516.) Before this time, but little injury can be sus- 
tained by a frequent indulgence at the breast ; but after this, it 
becomes highly important, both as regards the mother and the 
child. On the part of the mother it prevents an over-stimula- 
tion, and consequent weakness of the glands of the breast : it 
permits a gradual accumulation of milk in the milk-vessels, and 
gives time to the nipples to recover their tone, and thus pre- 
vents their becoming sore. On the part of the child, it prevents 
over-distention of the stomach; it prevents fretfulness, or cla- 
morous demands for the breast; and at night, especially, it per- 
mits it to sleep, and thereby gives ample opportunity for the 
digestion of the food it had previously received. On this ac- 
count, it is a good rule that the mother should suckle her child 
the last thing before she goes to bed. 

536. It is a common practice with many mothers, to permit 
the child to go to sleep at the breast. This should always be 
avoided, when possible ; for the fear in which the practice origi- 
nates is purely chimerical — namely, that the child may suffer 
during the night for want of nourishment. The frequent taking 
of the breast is entirely a habit; and one that is calculated to 
do mischief; as both the rest and digestion of the child are in- 
terrupted, to say nothing of the unnecessary fatigue to the 
mother. 

1 Mr. Friedlander condemns oysters, as being too heating. If this mean any 
thing, it must be that they are too stimulating. Now, this is very far from being 
confirmed by our own observation, or, we believe, that of any other physician in 
this country. We have ever found them to be nutritious, and void of all stimu- 
lating qualities; so much so, that they are the first articles we indulge our pa- 
tients with, on their return to convalescence. He has ranked them very unjustly 
with muscles, lobsters, crabs, &c, which are known to disagree very often, espe- 
cially in warm weather; whereas the oyster is very nutritious and bland, and 
rarely offends, like the others, by any peculiar quality. 



OF NURSING BY THE MOTHER. 149 

537. Occasionally, we have known the stomach reject these 
animal solutions. In such case, where the change of diet is 
desirable, we have found the substance itself, when divested 
entirely of its fat, answer very well ; it should, however, always 
be chopped up very fine, and given in very small quantities at a 
time. By this plan of feeding, several advantages arise : 1st, 
the child has the meat well divided by the knife, which could not 
always be done by the teeth; 2dly, if given in very small quan- 
tities, the child permits them to tarry in its mouth, until they 
become saturated with saliva — a circumstance of very great con- 
sequence to the process of digestion ; 3dly, it prevents the risk 
of temporary strangulation, as the bulk is not sufficiently great, 
when thus divided and given in small quantities, for this acci- 
dent to take place; consequently, a disgust to the food is not 
excited. 

538. At this period, also, that is, after a number of teeth are 
cut, the child may very profitably be indulged in the use of 
butter. Small pieces of good stale bread and butter may be 
given several times a day : the butter should, however, always 
be of the best quality; and unless this can be insured, it is de- 
cidedly best it should not be given. Some young children will 
not take it when spread upon bread; it may then be given alone, 
in small quantities at a time. 

539. Strong prejudices are entertained by some against the 
use of the last named article ; so much so, with a few, that it is 
entirely prohibited to young children, and sometimes even to 
older. The fear of butter originated in unfounded premises, and 
is perpetuated by absurd deductions. It is said, that in this 
climate, especially in warm weather, our diseases are almost all 
of a bilious character — butter is bilious; therefore, butter favours 
the dangerous tendency of the body. This absurd logic appears 
to be the sum of evidence against the use of this delightful and 
highly useful substance. 

540. For many years past our habits, as well as our duties, 
have led us to make observations upon the use of butter, as an 
article of diet, and especially for young children; and, from all 
that we can collect upon this subject, we are decidedly of opinion, 
that it is not only innocent, but highly useful. It is grateful to 
almost all children ; yet we do not recollect an instance where 
an indulgence in it was followed by the slightest injury, provided 
the butter were good. And as a medicine, in certain affections of 
the bowels, it constitutes in some instances an invaluable remedy, 
as we shall have occasion to notice in its proper place. 

541. Most people are in the habit of giving the potato to 
children of the age we are now noticing. The propriety of this, 
in our opinion, is very questionable; and we think its use should 
not only be very limited, but given with great caution. We have 



150 SECOND MEANS. 

oftentimes witnessed very distressing results from the too free 
use of this vegetable; and especially when it has been given, as 
it too frequently is, mixed with the gravy of meat. We have 
seen many instances of indigestion, cholera, colic, and some- 
times even convulsions, succeed a too free indulgence in this 
article. If the potato be used, it should always be well mashed, 
with a little hot milk, a small piece of fresh butter, and a little 
salt. This is the most unexceptionable mode of using it ; and 
even this should be given in small quantities at a time, and only 
to children beyond the ninth month. 1 

542. To some stomachs, the potato is uniformly exceptionable ; 
nor does a perseverance in its use, as has been often attempted, 
serve to reconcile it. This root does not contain as much nou- 
rishment as is generally supposed; and what there is, is very 
difficult of extraction to even a slightly enfeebled stomach. 
"Who has not seen it pass through the bowels in the precise 
condition it entered the stomach? And who has not known this 
friendly warning disregarded, until serious injury has arisen from 
a perseverance in its use? 

543. Many of the solid articles of diet have been- employed 
merely because they were solid; and this preference for solids 
has arisen from the vulgar belief that they are necessarily more 
nutritious than fluids ; than which, in many instances, nothing can 
be farther from the truth. Besides, it should be recollected, that 
before a solid can be converted into nourishment, it must be first 
reduced to the fluid state. 

Sect. II.-*- Second Means ; or ivhere the Mother is obliged to use 
artificial Means entirely. 

544. When the woman is obliged to give up suckling her child 
altogether, and prefers the second (520) to the third mode of 
nourishing it, she is under the necessity of conveying food to it, 
as we have already observed, (521) in one of two ways — namely, 
by the spoon, or by the bottle; and we at that time gave our 
reason for preferring the latter. We will now, however, say 
something farther on the subject of nourishing the child by the 
bottle. 

It must, however, be confessed, that the introduction of this highly valuable 
root has been attended with much good, even to young children, in countries 
where the means of life are scarce, and of course difficult to procure among the 
poorer classes of people. To these it has afforded a large supply of food, at a very 
moderate expense, besides its quality being absolutely better, than much of that 
which they were obliged to employ before its introduction — therefore, compara- 
tively, it is much better than many other roots before in common use. Thus 
Professor Lentin, (Friedlander, l'Education Physique de 1'Homme,) informs us 
that the comparison of deaths in his parish, before and since the introduction of 
the potato, is much in favour of this article. But all this only declares in favour 
of this root, where it is put in comparison with certain others; it does not prove 
it to be the best, or even equal to many other articles ; for instance, as good wheat 
flour, rice, arrow-root, sago, or tapioca. 



SECOND MEANS. 151 

545. We consider the use of the sucking bottle as a great im- 
provement in the rearing of children. Unquestionably it is one 
that is attended with the most entire success in very many in- 
stances, though we at the same time admit it to be accompanied 
with considerable trouble, although it be administered in the 
best manner; and must always be regarded but as a substitute 
for the breast. But where the choice lies between it and a hire- 
ling nurse, we should without hesitation give it the preference, 
unless our choice could be very securely made in regard to the 
latter; or there are existing some particular circumstances which 
render the bottle improper. 

546. There are cases, however, in which we should very much 
prefer the breast ; and this even at the hazard which must always 
attach in making choice of a person to fulfil the important duty 
of a nurse. These cases are, 1st, for a very young and feeble 
child: and especially where this weakness arises from its imma- 
turity; from a natural delicacy of constitution; or from the pre- 
vious illness of the mother ; 2dly, where the mother has a tainted 
constitution; and which taint has been in other instances, or may 
again be perpetuated to the offspring; 3dly, where the mother's 
milk has decidedly so far disagreed with the child as to produce 
either bowel complaints or great wasting ; 4thly, where the child 
is recovering from illness, particularly from complaints of the 
stomach and bowels; 5thly, and above all, where the experiment 
of the bottle has been fairly tried, and it has not been found to 
answer. 

547. When the bottle is used much care is required to pre- 
serve it sweet, and free from all impurities, or the remains of 
the former food, by which the present may be rendered impure, 
or sour; for this purpose, the following cautions must be ob- 
served: 1 

548. 1st. Never put a second supply of milk, or food, upon 
the remains of a former, unless a very short interval, only, has 
elapsed, and they are of the same making. 

549. 2d. As soon as the child has taken as much as disposed, 
or as may be judged proper for it, let the bottle be emptied, if 
any food remain, and immediately cleansed by hot water. 

550. 3d. When well cleansed by the hot water, let it be thrown 
into, and kept in a basin of cold water, in which there is a little 
soda dissolved. 

551. 4th. Before using it let it be well rinsed with clean cold 
water. 

1 It is not the bottle alone that requires this strict attention to cleanliness; it 
is every utensil that is employed, either in the preparing or receiving the nourish- 
ment of the child — for they may become either sour or impure, by some of the 
victuals adhering to them ; or they may be chemically acted upon; as vessels made 
of copper, or glazed earthenware. 



152 SECOND MEANS. 

552. 5th. Let the extremity, from which the child is to suck, 
be covered with a heifer's teat, in preference to any thing else ; 
and, with a view to its preservation, the following rules must be 
observed: — 

553. 1st. Let this teat be one that has been preserved in the 
best possible manner, by those who understand this art. 

554. 2dly. Let not the teat be of too large a size, nor one 
that will permit too rapid a flow of the food, especially for a 
very young child. If it be found to pass too freely, let the piece 
of sponge which is, or always should be, at its extremity, be 
either enlarged, or more strongly compressed. 

555. 3dly. Immediately after the bottle has been used, remove 
the teat from its mouth; and let it and the sponge be well washed 
and kept in a little whiskey and water, until again wanted. 
When reapplied, let it be attached by a piece of clean thread, as 
the former piece will be sour. 

556. From what we have said it will appear that we prefer 
the flat oblong bottle, with a teat, to the bottle and tube — and 
we do this for the following reasons : — 

557. 1st. The extremity of the tube is never so well received 
by the child as the teat; nor is it so comfortable to the mouth. 

558. 2d. The tube frequently becomes obstructed by the curd 
of the milk; and it is oftentimes difficult to remove it; and, if 
not removed, its objects will be defeated. 

559. 8d. It is much less convenient; requiring much more 
address in the management of it than the bottle. 

560. 4th. It is much more difficult to keep clean or sweet; 
and, consequently, must be improper in proportion to that dif- 
ficulty. 

5th. Besides, the flat bottle and teat need no re-heating of 
the food during the night, as it can be taken into the bed, and 
kept sufficiently warm by the heat of the body ; whereas, the tube 
and bottle require that the food must be warmed by a fire, which 
is found to be extremely troublesome, or the child must receive 
its nourishment cold. 

561. The food for the child in this artificial nursing is the 
same as we have already recommended, (248,) when only par- 
tially nursed by the bottle ; namely, the cow's milk, water, and 
sugar. 1 It should be frequently renewed, for the reasons we 
have already given ; and it should never be made too tenacious 

1 It is sometimes extremely difficult to get " cow's milk " that is good and 
sweet; in such case, an excellent substitute will be found in the "goat's milk,'' 
which can almost always be procured. In some of our southern slates milk bears 
a high price, and is excessively bad, the scarcity tempting people to adulterate it 
most plentifully with water, &c. The price of milk in Mobile is one dollar per 
gallon ; this offers a strong temptation to this fraud. It turns sour very soon : I 
have known it to be unfit for use in less than five hours. 



SECOND MEANS. * 153 

by the addition of other substances than those already recom- 
mended, as it will not pass through the pores of the teat, or 
through the tube with sufficient facility. 

562. Children brought up by artificial means in this country 
have subsisted almost altogether upon cow's milk, reduced as 
directed before. The European writers speak highly of the milk 
of other animals ; but of the qualities of* these we have had no 
opportunities to judge. Thus, the milk of the goat, the mare, 
the ass, &c, have been much praised for their nutritious and 
other qualities by different writers. 

563. Dr. Clarke, 1 of London, declares "the milk of the ass to 
be the best substitute for that of the mother. Cow's milk is too 
rich, containing too much oil and cheesy matter." We will, how- 
ever, give the results, which the analyses of the milk of several 
animals have afforded, agreeably to MM. Parmentier, Deyeux, 
and Vauquelin. 

564. One hundred pounds of milk gave of — 



Cream. 


Butter. 


Cheese. 


Sugai 


le Cow, 4^6 


91 1 


8}f 


3A 


Woman, 8}i 


3 


2*1 


?A 


Goat, 7 if 


4ft 


4| 


4f 


Ass, 2}f 




m 


^1 


Sheep, ll T 9 g 


6JI 


15| 


** 


Mare, \% 




If 


»A 



565. From this statement it would appear, that the milk of 
the ass and the mare approach nearer to that of the human, 
than any other yet analyzed. The milk of the mare is remarka- 
ble for its containing so little cream, and so large a proportion 
of sugar. 

566. But the nearer we can approach the qualities of the 
breast milk, the better will be our compound ; for nature has de- 
clared this to be the best possible pabulum for the child ; and 
there cannot well be a greater error than to suppose every addi- 
tion an improvement. We will not say that the substance just 
recommended is not susceptible of improvement: we mean only 
to declare, the simple mixture just mentioned to be the best we 
know for the child, up to a certain period — say, until it has cut 
several teeth. After this time, we may, should it be deemed ne- 
cessary, improve its nutritive qualities by the addition of gum 
Arabic water, barley, or rice water. We think we have seen de- 
cided advantages result from these additions, particularly from 
the gum Arabic water. Or, small quantities of some animal 
juice may be given in conjunction with the other preparation. 

567. But, let it be recollected, much mischief sometimes arises 

1 Commentaries, p. 56. 



154 SECOND MEANS. 

from a fastidious desire of improvement. The necessity for al- 
teration should always be ascertained before the change is made ; 
for it would be more than idle to insist upon a change of diet, 
while the child is rapidly or even perceptibly, improving ; espe- 
cially as the quantity of its food can readily be increased in 
the precise ratio to the necessity for such increase. Therefore, 
when it becomes desirable, from any cause, (as in certain stages 
of bowel complaints, &c.) that the quantity of food should not 
be increased, we may, with much advantage, sometimes increase 
its nutritive qualities by the addition of the above named sub- 
stances. 

568. It would be very desirable, could it be always regulated 
with sufficient certainty, to permit the child to take no more into 
its stomach at a time than this organ can assimilate in due time; 
for it has always been found better that the stomach crave food, 
than to be oppressed by an excess of it. The quantity given at 
a time must be regulated by the age of the child and by the 
force of its digestive powers ; and the periods for its exhibition 
must in some measure be governed by the same laws. 

569. As a general rule, such an interval should be allowed 
between each feeding as will insure the digestion of the previous 
quantity; and this may be fixed at about every three or four 
hours. The quantity to be given at each period may pretty suc- 
cessfully be determined by the avidity with which the child re- 
ceives it; for it will rarely demand more than it feels comforta- 
ble to receive — therefore, a little experience will enable any body 
to determine this point. When this matter is settled by repeated 
observation, it is proper that no more than has been generally 
sufficient, should be urged upon the child at that time, especially 
if it be taken rather reluctantly; but making at the same time 
due allowances for its advancing increase of size. There will 
also be constitutional differences as to the quantity which may 
be required; but this, to a woman of observation and care, will 
offer no embarrassment ; but it should, nevertheless, be attended 
to, that an undue quantity need not be urged upon the child in 
one instance, nor an insufficient one be given at another. 

570. There is one rule, which should constantly be attended 
to, especially as it is certain in its indications, and useful in its 
observance ; namely, when the child ceases to extract milk from 
the bottle, 1 and it be restored to it, and it refuse to take it, let 
it not, on any account, be urged to swallow more than nature 
seems to demand. 2 We are aware that this will occasionally 

1 This observation will hold good, and should be carefully observed, when the 
child is at the breast altogether. 

9 A good rule is never to put more in the bottle than appears necessary for the 
meal that is about to be given, for the child knows no discretion — but it can take 
no more than is within the bottle; therefore, if the proper quantity be put in, it 
will be sure not to overload its stomach. 



SECOND MEANS. 155 

happen, from a previous bad regulation — namely, feeding the 
child just before it is offered the bottle. But, be this as it may, 
the rule just laid down must be strictly observed. 

571. With children who are nourished by the breast this bu- 
siness is left almost altogether with the feelings of the child ; 
nor is this rule, in general, attended with any serious conse- 
quences. Should it take more than is really required, or than 
is agreeable to the stomach, it is soon regurgitated, and the un- 
easiness removed. But it is not exactly so in the artificial mode 
of rearing children; for the stomach does not so readily yield 
its contents, when it shall have become oppressed by quantity, 
as it does when it obtains its supplies from the breast ; and, on 
this very account, the artificial mode is less proper than the na- 
tural. It would seem that the milk of the mother has some in- 
herent quality which provokes the action of the stomach to cast 
it off as soon as it becomes offensive ; but this is not so much the 
case with the artificial food intended to supply its place. This, 
however, may arise from the one being drawn immediately from 
the breast, while the other has been exposed to the atmosphere, 
and suffered a change. The cow's milk contains more cheesy 
matter; and is, on this account, of more difficult assimilation — 
hence it is frequently thrown up in the form of hard curd. 

572. The stomach, therefore, will be more liable to these little 
inconveniences when confined to the bottle, than when it shall 
receive its natural supplies ; but a little careful observation on 
the part of the nurse will prevent any serious injury from this 
cause, as she will soon become familiar with the proper quantity 
to be administered; or, in other words, how much the stomach 
will bear without suffering from repletion. The quality of the 
food can be pretty much subjected to rule, by having regular 
proportions of the respective ingredients; and habit will soon 
enable a careful and observing woman to determine the quantity. 

573. We have already, upon several occasions, adverted to 
the care that is required in preparing and preserving in a proper 
condition the milk intended for the use of the child; we shall, 
therefore, only observe, in addition, that, upon no occasion, 
when the child is in health, will the milk require boiling. Boil- 
ing takes from the milk some of its best qualities, as may readily 
be detected by the smell, when this fluid has been subjected to it. 
It should, therefore, never suffer this change, as it can never be 
necessary while the child is in health. 

574. In hot weather, it is true, the tendency to decomposition 
is diminished by boiling the milk; but as all the advantages 
which may result from this process can be procured without its 
being absolutely boiled, it should never be had recourse to. It 
is every way sufficient for the purposes of preservation, that the 
milk be put, closely covered, over a hot fire, and brought quickly 



156 SECOND MEANS. 

to the boiling point: as soon as this is perceived, it should be 
removed and cooled as speedily as possible. 1 By this plan you 
prevent, in a great degree, the formation of that strong pellicle 
which is always observed upon the top of boiled milk, and by 
which the milk is deprived of a portion of one of its most valua- 
ble parts. 

575. The child should not receive its nourishment while lying 
— it should be raised, which will not only become a pleasanter 
position, but it also diminishes the risk of strangulation. After 
it has received a sufficient quantity of nourishment, which it 
should always do slowly, by stopping from time to time, it should 
be kept perfectly quiet for at least half an hour after each re- 
past; and if an attempt be made to use the common nursery 
promoter of digestion, namely, jolting, it should be immediately 
prohibited in the most decided and positive terms. This pre- 
posterous and highly injurious practice has become so familiar 
as to be overlooked as a cause of mischief; yet it merits more 
severe reprehension than might at first sight be imagined. 

576. As the future welfare of the child must necessarily, in 
part, depend upon the proper administration of its nourishment 
in the early part of its infancy, it must follow, if the due exhi- 
bition of it as regards quality and quantity be neglected, all the 
evils which can attach to deranged stomach and bowels must 
follow ; and if, on the other hand, there be no complaint to be 
made as to these two points, but, on the contrary, they are re- 
gularly and judiciously ordered, but all their advantages de- 
stroyed by digestion being interrupted, it must follow that the 
practice which shall do this cannot be too severely condemned — 
therefore, the barbarous practice of jolting the child immediately 
after each meal, or, perhaps, after each portion of it, should be 
strictly forbidden. 

577. For a certain period after each meal rest is as essential to 
digestion as exercise is important at other times to the general pro- 
motion of health — therefore, whatever interrupts or interferes with 
this repose, at once defeats the kindest intentions of nature towards 
this passive and interesting part of creation. Analogous to 
jolting is the absurd and oftentimes dangerous practice of toss- 
ing the child high, in such quick succession that respiration is 
oftentimes suspended. Some seem to know no other mode of 
nursing a young child than that of rudely tossing it about ; and 
we have oftentimes been gratified by the disturbed stomach in- 
dignantly pouring out its contents, to the dreadful annoyance of 
the holiday clothes of the boisterous and thoughtless pro tern- 

1 An excellent method to warm milk, is by a sand bath; which any body may 
command, by part filling an iron pot with dry sand. If the milk be placed in a 
proper vessel in this bath, it may be heated by setting it over coals, or it may be 
placed upon a stove until it acquires a proper warmth. 



SECOND MEANS. 157 

pore nurse, who forced it to this retaliation. Nothing can speak 
in plainer language than the insulted stomach upon such occa- 
sions; as it at once declares the evils -which must ensue when- 
ever its functions are thus cruelly interfered with. 

578. We have often observed the bottle to become the play- 
thing of the child. This has arisen, most probably, from the 
mother or nurse not having as much leisure as duties to the child 
might require — the bottle is then given to appease its immediate 
clamors, and afterwards suffered to remain with it, that they may 
not be renewed. This is decidedly very injudicious, if any thing 
more than quieting the child be considered of any consequence. 

57Q. By this plan the child receives a fresh supply of food 
every few minutes, without giving time for the previous quanti- 
ty to be disposed of; the process of digestion is, therefore, never 
completed, or is constantly interrupted. In consequence of this, 
a great part of the food passes from the stomach into the bowels 
nearly in the condition it was received, or but imperfectly assi- 
milated; and it is there subjected to a sufficiently long delay to 
ferment or to become sour; colic, diarrhoea, or both, are the 
result. Besides, the child is deprived, by this plan, of a consi- 
derable portion of its nourishment; for not only that which has 
undergone a change, but also that which has not, escapes from 
the stomach, and passes through the bowels, without contributing 
to the nourishment of the body. Hence children who are al- 
ways eating are never fat. 

580. There is also another evil arising from this mode of ad- 
ministering nourishment to the child — namely the food becomes 
sour, or nearly so, before it is taken into the stomach, by its 
being kept constantly heated by the child's hands and body — 
the impropriety of this will at once strike every body. 

581. Rousseau has advanced some strange sentiments upon 
the subject of milk. He says, "The milk of those women who 
live chiefly on vegetables is more sweet and salutary than that 
of carnivorous females." More salutary to whom, or to what? 
Does not this imply an imperfection, and a contradiction, in the 
works of nature? The milk produced by a mixed diet would 
certainly be most proper for such animals as naturally live upon 
mixed food; but would this be as sweet and as salutary to the 
young of the animal which feeds upon animal substances alone ? 
We believe not — for there is every reason to suppose the milk 
to be suited exactly to the powers of their digestive organs. If 
he mean that the milk of animals strictly carnivorous would be 
less sweet and salutary to those who are destined to be support- 
ed by milk from a mixed diet, we would most readily agree with 
him; but this would be begging the question. Now, as there is 
not in civilized life one woman, in ten thousand, who lives upon 
animal food alone, it must follow that children deriving nourish- 



158 SECOND MEANS. 

ment from the breast, must receive milk of a mixed character ; 
and that appears to be as much as we have a right to expect. 

582. If there be any truth in the opinion of naturalists upon 
the nature of man as regards his food, it will be found that he is 
intended to eat of both animal and vegetable substances; there- 
fore, to confine him exclusively to either would be as preposte- 
rous as to urge animal substances upon the cow, or to force vege- 
tables on the tiger. 

583. Rousseau farther attempts to support his position by de- 
claring that " every body knows that pulse and vegetables in- 
crease the quantity of blood more than meat." Now, this is not 
known to every body, nor to any body, and, consequently, his 
question, "Why, therefore, not milk?" which immediately fol- 
lows, and is intended as a deduction, answers itself. 

584. He admits that vegetable aliment may, possibly, make 
the milk more apt to turn sour; but he says, "I am very far 
from regarding sour milk as an unwholesome nutriment. There 
are people in some countries who have no other, and yet are in 
good health." This is novel to us — and we regret he has not 
left us some indication of the country where the cows give no- 
thing but sour milk. He most probably means there are people 
who prefer milk in this condition, to sweet — -this maybe; but 
we do not believe there is a nation subsisting upon sour milk 
alone, and in good health, as this passage would seem to imply. 

585. This observation is. not confirmed by any other writer; 
it is certainly contrary to our own experience, and we believe to 
that of every body else, who has not a theory to support. But 
Rousseau appears to be determined upon this point, since he en- 
lists in his favour the circumstance that milk must be coagulated 1 
in the stomach, before it is converted into nourishment. But 
he was an indifferent physiologist, or he would have known that 
the change produced upon the milk, by the proper action of the 
stomach, is very different from that curdling which is the effect 
of spontaneous decomposition; the one is necessary to its due 
elaboration ; the other, if not positively injurious, taxes the pow- 
ers of the stomach pretty highly to subdue it to proper chyme. 2 

586. It will also readily occur to any one who will give this 
important matter a due consideration, that the bottle with mo- 
thers or nurses who are too much limited for time to bestow the 
necessary attentions on the child, will not succeed so well as it 
does in the hands of those who have more leisure; for their re- 

1 But the coagulation alluded to by Rousseau, and which takes place spontane- 
ously in the stomach of healthy children, is not the coagulation produced by 
acidity; it is similar to that which takes place out of the body by " rennet." 

2 Chyme is the imperfectly digested mass that is subjected to the influence of 
the bile and pancreatic juice in the duodenum, that it may be converted into chyle 
after it leaves the stomach. 



THIRD MEANS. 159 

stricted time prevents such attention to the state of the bottle 
as is essential to its success. If due care be not paid to its 
being properly and very often cleansed, it must fail of being as 
useful to the child as it should be. Cleanliness must, therefore, 
in this, as in many other instances, be considered as a sine quel 
?ion to the success of the bottle plan of raising children. 

587. We mentioned, in our account of the manner of pre- 
paring the cow's milk for the use of the child, (248,) that a small 
portion of loaf sugar should be added ; but did not, at that time, 
lay much stress upon this ingredient. We shall, therefore, take 
this opportunity to observe that this direction should always be 
strictly complied with; for the substitution of brown sugar, or 
molasses, may often be attended with much inconvenience, 
especially with very young children, by becoming acid much 
sooner than good loaf sugar ; and, for a purpose like this, the 
difference of price cannot be considered an object. 

Sect. III. — Third Means; or employing a wet nurse. 

588. We have already stated that, under some circumstances, 
a " wet nurse," with all the penalties that may attend the choice, 
is to be preferred to the greater, or worse risk, of the child 
perishing without one. But as this is a matter of necessity, and 
not of election, we must endeavour to diminish the evil as much 
as may be in our power by selecting with as much care and 
judgment as circumstances will permit, one with as few faults 
as possible. There is, oftentimes, a great difference in those 
who may offer for this purpose ; so much so, indeed, as to render 
it highly important to be acquainted with a few general rules to 
aid in the selection. 

589. It may justly be a question in morals, how far one part 
of society has a right to be benefited by the injury of another. 
The avowed object in employing a wet nurse is to benefit the 
child for whom she is employed. To do this she must generally 
abandon her own child, either to a mercenary as selfish as her- 
self, or allow it to be brought up by ill-conducted or worse 
adapted means ; for the mother who abandons her own child to 
suckle that of another must do it from the expectation of gain : 
this she cannot realize but by procuring a place for her own, at 
a price lower than that which she herself is receiving ; and, un- 
fortunately for the poor child, this kind of calculation is but too 
well understood by that elass of people to whom these remarks 
will apply; for they will most scrupulously regulate the quid pro 
quo, by the sine qud non. 

590. On this subject Dr. Clarke makes the following pointed 
but just remarks: "If the child live for whom the wet nurse is 
invited by the prospect of gain to forsake her own, the child of 



160 THIRD MEANS. 

the wet nurse often dies, or it becomes diseased, or crippled. 
Her own children are neglected, and her husband, for want of 
her society, becomes drunken and profligate ; she rarely returns 
home contented with her former situation, but compares her 
present privations with the indulgences which she has left ; the 
whole comfort of the labouring man's fireside is broken up, and 
society has only exchanged the life of one child for that of an- 
other, with all the disadvantages above enumerated." 

591. " On the whole," continues the Dr., " it would be better, 
perhaps, that the children of the wealthy should be brought up 
artificially, where the mother does not suckle, because they 
would have every advantage of good nursing, cleanliness, air, 
and medical treatment; and would, therefore, have a better 
chance of living than the child of the wet nurse, who will want 
all these advantages." 1 

592. In our opinion there is but one method to remove the 
objections so strongly and truly urged against the system of wet 
nursing here described, and this is very far from being free from 
objections; which is, by employing none but those unfortunate 
females who have been by " love betrayed," and such only of 
these as may have lost their children. This plan would con- 
siderably reduce the number of hireling nurses ; but, from this 
very circumstance, we see that several serious disadvantages 
might arise: 1st, it would lead, in many instances, perhaps, to 
the neglect, and ultimate death, of their own children; 2dly, it 
would increase very much the price of their services, which 
would operate as a bounty on their want of chastity. This view 
of the subject should, therefore, become an additional reason to 
the mother to suckle her own child, whenever practicable. 

593. It is true Dr. Clarke proposes another plan, which m 
our opinion is liable to objections: but we will give his scheme 
in his own words. "With every attention which can be paid to 
them, children brought up by hand will often die. Perhaps the 
most desirable thing would be, that a strong wet nurse should, 
as far as she is able, suckle her own and the foster child; and 
that the deficiency of both should be supplied by artificial 
means." 2 

594. The objection to this plan is at once obvious, by refer- 
ring to a principle in human nature, and on which we have else- 
where passed a remark, (615,) that the child of the nurse would 
be nourished, to the exclusion of the foster child. But to return. 

595. Did we undertake to declare in what a good nurse con- 
sists, "we should be considered," says Mr. Eriedlander, 3 "as 
describing an ideal being. For she should neither be too young 

1 Commentaries, p. 52. 9 Ibid. p. 54. 

■ L'Education Physique de l'Homme, p. 60. 



THIRD MEANS. 161 

nor too old; as, before she is twenty, she has not arrived at her 
full development; and, after thirty-five, she is upon the decline. 
She should be well constituted; she should neither be too fat 
nor too lean; she should be fresh-coloured; have fine teeth, red 
lips, and sweet breath; her hair should not be too black, nor too 
deep a red, nor should she be subject to any violent passion. 
Her breast should be of moderate size, with a nipple sufficiently 
projecting and irritable, and yielding milk upon the slightest 
force ; her milk should neither be too thick nor too transparent, 
and of an agreeable, sweet taste. Added to these, she should 
have proper moral feelings, to second such useful qualities. Nor 
should these good qualities be debased by bad passions or other 
defect of character. She should so regulate her diet as to be 
entirely subservient to the advantage of the child." 

596. Or, as this has been more elegantly expressed by Saint 
Marthe, in his Psedotrophia, as translated by Dr. Tytler : 

" Choose one of middle age, nor old nor young, 

Nor plump, nor slim, her make, but firm and strong; 

Upon her cheek let health refulgent glow, 

In vivid colours/ that good humour show. 

Long be her arms, and broad her ample chest, 

Her neck be finely turned, and full her breast; 

Let the twin hills be white as mountain snow, 

Their swelling veins with circling juices flow; 

Each in a well projecting nipple end, 

And milk in copious streams from these descend. 

Remember, too, the whitest milk you meet, 

Of grateful flavour, pleasing taste, and sweet, 

Is always best: and if it strongly scent 

The air, some latent ill the vessels vent. 75 

597. To this we would add, (what appears to have escaped 
the above judicious author,) an exemption from her catamenia. 
"We are, however, by no means sure, that he, and many beside, 
would consider this a defect in the character of a nurse, as gene- 
ral opinion is in its favour : 2 on this account, it is worthy of in- 
vestigation. It is a very common belief among females, that 
at each return of the catamenial discharge during lactation there 
is a renewal of "the milk." We have very often had this cir- 
cumstance whispered in our ear by some good old woman, who 
might be recommending a young friend for the office in question, 
with an emphasis that bespoke at least the firmness of her be- 
lief, if not the soundness of her philosophy. Indeed, so common 
is this opinion among " nurses," that it has even been "simi- 

1 This rule, however, in this country, at least, is liable to many exceptions, 
since the very best nurses we have ever seen have been pale. 

3 Struve observes, upon this subject, (p. 233,) "A nurse's monthly discharges 
should either stop entirely, or take place only in a moderate degree, lest the milk 
might soon disappear." 



162 THIRD MEANS. 

lated," to enhance the value of the applicant, and to insure her 
success. 

598. But, unfortunately for such as may attempt to take ad- 
vantage of such a circumstance, or impose by a mere declaration 
of it, it must, by all who will duly weigh the subject, be con- 
sidered as operating against the fitness of the individual who 
may be so situated. For nature neither acts idly nor capri- 
ciously; and, though there maybe occasional deviations from her 
usual scheme, they must be regarded but as exceptions to the 
general rule. 

599. The laws of nature on the subject in question, are al- 
most invariably as follows : — 1st, As soon as the catamenial dis- 
charge is arrested, in consequence of pregnancy, the breasts al- 
most immediately undergo a change ; a change which is important, 
because preparative of the great office they are to perform sub- 
sequently. 2dly, As soon almost as delivery has taken place, 
the breasts plentifully secrete nourishment for the child, and 
during a long period, faithfully discharge this important duty ; 
but in the mean time, the catamenial evacuation is arrested, and 
continues to be so, in most instances, to any period almost, that 
the child may continue at the breast. 3dly, At the time ap- 
pointed, as a general law of nature, for the reappearance of the 
catanienia, (which is from the twelfth to the fourteenth month,) 
and this evacuation is again established, the milk is found in- 
variably to diminish in quantity, and, also, to deteriorate in 
quality ; and the child to be but imperfectly nourished. The 
truth of these positions we are sure will not be challenged. 

600. Now, if this be true, is it not worse than idle to declare, 
that the exception which nature makes to her general rule, should 
be better calculated for the good of the being, than the rule it- 
self? If this discharge were so efficient in the production of 
milk for the benefit of the child, why would not nature have 
chosen this for the general law, and the suppression of it for 
the exception? Or, why is the milk not renewed and improved, 
upon the natural return of this evacuation? For these reasons, 
we have invariably objected to such nurses. Dr. Marshall Hall 
says, 1 "It has been noticed that the return of the catamenial 
period is usually attended by a tumid state of the mamma. It 
is not, therefore, surprising, that a diseased state of the uterine 
functions should induce a morbid condition of the latter organ. 
Such a morbid condition of the uterus may, indeed, be frequently 
traced as the cause of a morbid affection of the mammae: in some 
cases it has excited tumours in the substance of the mammae; in 
other instances, it has disordered their secretion, and ultimately 
proved the cause of derangement of the health of the infant. A 

1 On some of the Diseases of Females, p. 142. 



THIRD MEANS. 163 

familiar example of this occurs in those mothers who have begun 
to menstruate before they have ceased from suckling: at each re- 
turn of the catamenia the child is, in many instances, distinctly 
disordered in health." 

601. The age of the milk, as it is called, should constantly be 
taken into consideration. This is always an important point; 
and its value is well known to those who are to be subjected to 
inquiry, since they will always declare it to be of an early age, 
should this be necessary. We have no certain marks to direct 
us upon this point: we have, therefore, almost exclusively to 
rely upon the testimony of those whose interest it is to deceive, 
should the truth make against them. When truth can be elicited, 
either by testimony or circumstance, we should always prefer 
the "young milk," when it can be had, even for an older child, 
provided the disparity be not too great; and for this plain rea- 
son : — it will, (all things being equal) last longer, and be in better 
condition. 

602. It is a received opinion, and generally it is well-founded, 
that the substituted milk should be, as nearly as possible, of the 
same age as the child who is to receive it. In many instances, 
there cannot be any disadvantage in the observance of this rule, 
but there need be no absolute conformity to it; since there is no 
necessary and progressive correspondence in the age of the child 
and the quality of the milk, after the third or fourth month. 
Up to this period, as a general rule, the milk is not so nutritious 
as afterward; but this defect, if it be so, is almost constantly 
compensated for by its greater abundance; and this excess can 
be profitably employed by an older child, so that even this young 
milk for an older child cannot be considered as a serious objection. 
But the converse of this rule will not hold good; nor should it 
ever be acted upon but as a dernier resource, since, after the 
twelfth or thirteenth month, the milk almost always diminishes 
in quantity, as well as deteriorates in quality. 

603. Yet it must be confessed there is no fact, perhaps, bet- 
ter ascertained, than that the milk undergoes changes as the 
period increases from the time of delivery, but not always ad- 
vantageously ; that is, it is less nutritious in the first few months 
than it becomes afterwards, in obedience to the law we have 
elsewhere recognised; namely, that the nutritive quality of the 
milk is generally governed by the capacity of the stomach to di- 
gest it, and by the greater or less necessities of the system. 
This rule, however, has its limits, agreeably to another law — 
that, as the teeth begin to show themselves, the milk may be 
aided by the administration of other substances, as the increasing 
demand of the system may require such aid ; hence, as has just 
been observed, the deterioration of the milk after the twelfth or 
thirteenth month. 

604. A nurse should be able to suckle with both breasts; not 



164 THIRD MEANS. 

altogether, perhaps, from the apprehension that one may not be 
able to furnish a sufficient supply, but because, when the child 
is constantly nursed from one, it sometimes contracts a crooked- 
ness of form. And we may also urge, collaterally, there will 
be, most probably, not only a more abundant supply, but also a 
greater security for its continuance from two; since an accident 
may befall the one, and thus deprive the child at once of its 
nourishment. 

605. We may also urge another observance upon women who 
suckle from both breasts, and which should not be neglected, 
and it may be considered as an additional argument in favour of 
two breasts — namely, that the child may be nourished alternately 
from them, to prevent the constant direction of its eyes towards 
one point, and thus produce the ugly habit of squinting. This 
direction should be acted upon from the beginning, that the child 
may not have a favourite breast established ; which is very apt 
to be done, by a little carelessness on the part of the nurse, or 
from some cause in the breast itself. 

606. On the part of the nurse, this habit may be produced by 
her being able to manage the child more adroitly on one side 
than the other; and, on the part of the breast itself, it may 
be owing to the nipple being better on the one breast than on 
the other ; or to the milk coming freer from one breast than the 
other ; or its being too free from one of the breasts. This ca- 
price of the child, however, should not be indulged, if it can 
possibly be prevented, and for reasons that may be collected 
from what has just been said. • 

607. It is far from being uncommon for the milk to flow too 
rapidly for the feeble powers of deglutition of the child; thus 
threatening it with strangulation. When a nipple is thus situ- 
ated, the mother should try to prevent it by gently compressing 
it while the child is sucking. We have known nurses obviate 
this inconvenience by making a ligature of white yarn to press 
gently around the nipple. 

608. Much reliance is placed upon the appearance of the 
milk; more, perhaps, than it really deserves; since there is, 
most probably, a slight difference in appearance in each indivi- 
dual, as well as from the age of the milk itself, without neces- 
sarily affecting its properties ; at least, we know this to be the 
case with the milk of cows. Farmers who are in the habit of 
attending much to cattle will, from the colour and form of the 
cow, very nearly determine her capacity to produce milk, either 
as regards its quantity, or its power to yield cream. Yet, in 
neither of these instances, would one milk be said to be more 
wholesome than the other. It is, therefore, possible that com- 
plexion in the human female may have a certain quality of milk 
attached to it; and hence, perhaps, arise the objections to the 



THIRD MEANS. 165 

very black, or very red-haired woman, who may present them- 
selves as nurses ; in either of which the milk may not be found 
equal in quality to that yielded by women who have hair of the 
intermediate shades of colour. 

609. But, perhaps, in the red-haired women, there may be cer- 
tain moral qualities that may unfit them for the office of nurses : 
they are certainly of a sanguine temperament, and this tem- 
perament has attached to it great irritability of temper as one 
of its characteristics — hence, in a moral point of view, their 
unfitness as protectors of young children.. Among the ancients, 
especially among the Romans, the moral qualities were considered 
of more consequence than the physical capacities of a nurse; 
and by them consequences of such moment and extent were at- 
tributed to them, as, at the present day, at least, we should not 
expect to find realized. The habit of intoxication, to which Nero 
so immoderately yielded himself, was said to be owing to the in- 
fluence of a drunken nurse; and the blood-thirsty disposition of 
Caligula was attributed to the nipple being smeared with blood, 
to invite him to take it with more certainty, by his savage foster 
parent. 

610. We have never ourselves looked upon those stories but 
as powerful and ingenious fables, to rouse the sympathies of the 
mother to the delightful duty of nursing her own child. But 
every body is aware of the influence of example — too much care, 
therefore, cannot be taken, that the nurse exhibit no improper 
ones. Every precaution will be observed on her part to conceal 
her frailties, however watchful the mother may be to detect them ; 
for this reason, the child should be as little as may be from un- 
der the mother's eye, that the evil may thereby be diminished 
as much as possible. Let the nurse be considered as the organ 
of supply, but not as the object of example; commit to her 
charge as few duties as possible, and let the mother assume to 
herself every other but that of suckling, and a few of the meaner 
mechanical parts, which should and must properly be considered 
as belonging to the nurse. 

611. If this were more constantly done, it would tend much 
to diminish the inconvenience, and at the same time remove 
many of the objections, to the " wet nurse ;" for by it many evils 
would be removed. By this plan the affections of the child 
would be as much due to the real, as to the foster mother; and 
that most painful of all sensations, of seeing the affections of 
our child transferred to another, would in a great measure be 
avoided. By this plan, the manners of the plastic child could 
be moulded by the will of its proper guardian, instead of being 
subjected to that of a hireling. And, though last, perhaps 
not least, the affections of the parent would not be estranged 
from that child which necessity had obliged her to rear by an 



166 THIRD MEANS. 

alien breast. We are well acquainted with the father and mother 
of a child that was nursed abroad ; and though they frequently 
saw it, and it was returned to them at eighteen months old, they 
both confess they have less affection for this little unfortunate 
than for the rest of their children. It is a source of constant 
misery to them ; and though the child is perfectly a stranger to 
the diminished affection of its parents, and has in every respect, 
the same attention, and the same apparent love bestowed upon 
it, and, consequently, by these means suffers no real injury, still, 
to the parents, it is the cause of endless regret. We confess 
there may be a little too much refinement in this kind of sensi- 
bility ; since with them, or rather with the mother, it amounts 
to self-reproach, though the necessity of sending the child away 
was imperious: but a fear is constantly presenting itself to her 
over-sensitive mind, that she may fail in her duties towards it, 
though she is constantly watching herself, to prevent the slight- 
est neglect. 

612. With feelings like these, there can be little risk that the 
child will suffer from neglect, but if such apprehensions arise in 
the mind of a conscientious mother, what may not actually hap- 
pen with those who have no such scruples against which to con- 
tend? It, at least, makes an additional, as well as a strong 
objection against wet nursing; and especially against that still 
more exceptional form of it, putting the child out of the house 
for the purpose. By this practice, all the evils which can possibly 
befall an infant repudiated from its mother's bosom will exist in 
a higher degree than when it may be nourished in the house ; 
because it is now removed from the surveillance of a watchful 
parent — the only security it can have, that proper attention shall 
be bestowed upon it. 

613. Here it will be doomed to all the penalties that await 
neglect of every kind, by the absence of the only feeling that 
can bear up against the exercise of it — namely, a mother's love. 
Ask any mother, how much love it requires to fulfil, justly, the 
duties of one ? Then ask, can these duties, duties so varied, so 
multiplied, so essential to the happiness, nay, almost the exist- 
ence of the helpless little one, be performed in the absence of 
such affection ? The answer is no less easy than true — No ! We 
will not go so far as to say that there is no exception to this rule 
— we believe there may have been, and may be again: but the 
chance is like the high prize of every lottery ; and, like all dealers 
in this species of gambling, each trusts he may be the holder of 
the fortunate ticket; and the evil is thus perpetuated. 

614. Nothing will so certainly insure neglect to the child, as 
a want of affection for it — whether this want of love be on the 
part of the mother or the nurse. It is unnatural on the part of 
the mother, and it must be sorely lamented that it happens ; since, 



THIRD MEANS. 167 

from the want of it, she is deprived of one of the purest pleasures 
on this earth, and, at the same time, loses the strongest incentive 
to the discharge of her duties. On the part of the nurse, it is 
not to be so much wondered at, or so severely condemned; for 
she has either lost her own child, and cannot suddenly transfer 
her affections to another, or it is put from her by necessity, that 
she may foster the child of a stranger: — she dwells upon her 
privation ; her mind teems with a thousand apprehensions ; and, 
in spite of her best wishes to the contrary, she must look upon 
her little charge as a usurper of the rights of her own. During 
this period of conflict, the child is often the sufferer, from a want 
of that attention which a proper affection would have insured, and 
dies, perhaps, before this necessary love is generated, because it 
had been too long withheld. 

615. Let us, for a moment, look more closely at the case we 
are now considering, that its enormities may the more easily be 
exposed. A woman consents that a child shall share her bosom 
with her own ; the motive, doubtless, is, the reward it will bring, 
— this at once declares that poverty or avarice is the cause of 
that motive ; it is therefore a mercenary transaction. She is 
remote from the watchful superintendence of the mother who 
has committed her child to her care; she is, consequently, under 
no restraint as to conduct: the child is, therefore, treated as 
circumstances or caprice may direct. If a deficiency of milk 
occur, an event common to all nurses, and an allowance is to be 
awarded, to which is it natural she should give the larger share ? 
Her own child ! Or, perhaps, she may yield the whole, making 
the other conform to the necessity, by giving it an improper 
substitute for the milk of her breast. Again : if the child be not 
deprived of its proper nourishment, it may be sadly abridged of 
the time necessary to its comfort or essential to its health — filth 
and all kinds of uncleanliness, and even disease, dependent upon 
neglect, will be heaped upon the passive child thus committed to 
the care of an unprincipled nurse, because a mother's eye cannot 
watch, or a mother's vengeance overtake, the horrid breach of 
trust. 

616. Besides, other evils may arise, of a still more serious 
kind, by this mode of nursing. Dr. Struve, (p. 235,) quotes an 
anonymous German author of a work on "Matrimony," for an 
anecdote of a young Count, 1 whose features bear so exact a re- 
semblance to those of his foster mother, that a strong presump- 
tion arises against the justice of his claims to the paternal title 
and estate — dreadful substitution ! 

617. When necessity obliges a parent to put away her child, 
let her seek a home for it in the country; and, if possible, place 
it with one who may have had the misfortune to lose her own; 
and whose situation in life would place her above a mere mer- 
cenary hireling. So placed, the child would have the best pos- 



168 THIRD MEANS. 

sible chance for health, care and proper nourishment — conse- 
quently the great ends of nursing would be entirely answered. 
It can never be safe to trust a child for this purpose in a city, 
for reasons sufficiently obvious, — it cannot receive the benefit of 
fresh air, especially in summer; it cannot have that attention 
paid to cleanliness that is so important to its health; nor receive 
a sufficient quantity of nourishment, if it divide the quantity with 
another ; since the person who would undertake the charge cannot 
live in a proper situation to afford the first, nor will she have 
leisure to attend to the second; and her feelings for her own 
child will, most probably, tempt her to an unfair division of the 
third. 

618. It must, however, be acknowledged, that a wet nurse has 
in many instances a hard duty to perform. She is narrowly 
watched in every movement and in every act; she is sometimes 
forced to endure the caprice, the revilings, and censures of a 
wayward and over-fastidious parent — forced to swallow food she 
loathes ; deprived of that to which she has been accustomed, and 
had always found to agree with her — and should the child 
be ill, it is owing to her neglect; if in pain, to the improper in- 
dulgence of her appetite. And when the time of her probation 
has nearly expired, pains are taken to alienate the affections of 
her charge from her, that the self-love of the mother need not 
be too severely wounded — she is, perhaps, for a time, even for- 
bidden a house she has left with a sincere regret, because she 
bore a strong love for the child she fostered. And, though we 
consider the child's exclusive love of the nurse as one of the 
evils attending their employment, yet we should be sorry to see 
the faithful discharge of duties rewarded in this way. 

619. Did the evil stop here, it would not be so great ; but this 
conduct, as Rousseau justly observes, "instead of making an 
affectionate son of an unnatural nurse child, only excites his in- 
gratitude, and teaches him one day to despise her who gave 
him life, as he already despises her who nursed him with her 
milk." 

620. Hitherto we have said nothing upon the subject of drinks 
for the child during the period we have been conducting our in- 
quiries; having reserved its consideration until now, as a very 
few words will be sufficient upon this head, though much error 
prevails on it. It is a practice with many, and especially with 
people in the lower walks of life, to commence at a very early 
period of the child's life, to give it a variety of drinks, composed 
of ardent or fermented liquors; urging, in defence of the prac- 
tice, that "children should become accustomed to eat and drink 
every thing." 

621. We have witnessed, very often, with sorrow, parents 
giving to their young children wine, or other stimulating liquors : 



OF WEANING. 169 

nature never intended any thing stronger than water, to be the 
drink for children — this they enjoy greatly; and much advantage 
is occasionally experienced from its use, especially after children 
have commenced the use of animal food. 

622. In the western parts of our state, where ardent spirit has 
become almost the substitute for water, whiskey is given daily in 
large quantities, from the youngest to the oldest child ; and, so 
quickly do they become accustomed to this pernicious liquor, that 
we have seen a child of six or seven years old drink a wine-glass 
full at a draught. The consequence of such a practice can but 
too easily be foreseen. The directions for the use of drinks, then, 
can be summed up in a very few words — namely, that nothing 
but pure water should be given to healthy children. If they be 
diseased, they come under the direction of the physician ; and his 
province should never be usurped. 

623. We have often noticed with how much pleasure even very 
young children take from time to time small quantities of cold 
water; and we believe there can be no good reason assigned for 
withholding its occasional use, though we confess we are at a loss 
to account for its great success in curing belly-ache, as many 
good old ladies tell us it does. We think we have seen it very 
frequently interrupt hiccough ; and we have every reason to be- 
lieve it to be both innocent and grateful to the little creatures, 
especially during the painful and feverish process of teething. 



CHAPTER VII. 



SECOND PEKIOD-OF WEANING. 



624. When the child arrives at a certain age, it is, generally, 
taken from the breast; and that separation is called " weaning." 
This, to an affectionate mother, is a period as full of solicitude 
as of pain; and it is consented to with a reluctance that declares 
the pleasure the act of suckling had procured, as well as betrays 
anticipations of dangers, which may too certainly await the 
change. When weaning is determined upon, from the mere age 
of the child, it is not at all surprising that maternal solicitude 
should be powerfully awakened; since this rule, if implicitly fol- 
lowed, must necessarily have its victims. The propriety, there- 
fore, of this separation, must depend upon several circumstances, 
that it may not prove destructive or injurious to the individuals 
concerned. These circumstances may belong — 1st, to the mother; 
2dly, to the child; 3dly, to the season of the year. 



170 OF WEANING. 

Sect. I. — On the part of the Mother. 

625. There are circumstances, on the part of the mother, which 
may render it ineligible, or even improper, she should continue 
to suckle her child — 1st, she may be attacked with some consti- 
tutional affection, which may so reduce her, as to make it highly 
improper she should keep the child longer at the breast; she may 
be seized with some acute disease, which may require repeated 
and extensive depletion : so much so, indeed, as to prevent the 
system from furnishing the proper quantity of food necessary to 
nourish the child, yet sufficient to increase the debility of the 
mother, and retard her convalescence. It may, also, become 
necessary to keep the child from the breast during the very acute 
stages of fever; as the fatigue of suckling may do much injury 
by increasing the activity of the blood vessels. 

626. In febrile affections of the mother it may be proper, 
however, to observe that the child is never to be withheld from 
the breast under the apprehension that it may receive injury; it 
is only to prevent, in such cases, the mother suffering from fa- 
tigue. As regards the child, we feel the fullest confidence in 
the truth of our observations, when we say, we have never wit- 
nessed the smallest injury from permitting it to take the breast 
under the most violent forms of fever. In the yellow fever itself, 
we have a number of times witnessed its most perfect exemption 
from injury, during the entire progress of this disease, and even, 
indeed, to its fatal termination. Therefore, as regards the child, 
we repeat, its safety, we believe, is never menaced from these 
causes. Yet under such circumstances it may be highly impor- 
tant to the mother's safety, or necessary to her comfort, that the 
child be kept from her. And, should the child be of a proper 
age, or in a proper condition for weaning, as we shall indicate 
presently, it may be proper to do it at this time. 

627. 2dly. The mother may be attacked with some local af- 
fection that may render suckling extremely inconvenient, as well 
as improper; as milk abscess. In such case, the breasts may 
be so inflamed, and the milk-vessels so impacted, that much 
injury might be done by the attempt to suckle. Under such 
circumstances, all things being equal, it would be best to sepa- 
rate the child. 

628. 3dly. The supply of milk may be so diminished, even 
without an evident cause, as to render it altogether insufficient 
for the support of the child; consequently, both may be injured 
by a perseverance. If this happen, it will be best, under proper 
circumstances, to wean the child. In a word, whenever any 
thing decidedly injurious to the mother's health, is increased by 
suckling, it should always be considered as a sufficient reason for 
separating the child; or whenever any thing occurs on the part 



OF WEANING. 171 

of the mother, which so alters the quality of the milk, or so di- 
minishes the quantity, as to render it improper or insufficient for 
the support of the child, it should be regarded as a legitimate 
reason for taking the child from the breast ; and if every thing 
concur on the part of the child to render weaning proper, it 
should be done immediately. 

629. 4thly. The woman may become pregnant while suckling ; 
and this condition has ever been considered as a conclusive rea- 
son for weaning, be the age of the child what it may. We are, 
however, of opinion, that this notion has been too hastily as- 
sumed; or, at least, has been too generally acted upon. There 
can be but two reasons why a pregnant woman should not suckle 
her child — 1st, an alteration in the quality of the milk; and, 
2dly, a great diminution of its quantity. But these reasons 
would be valid upon any other occasion ; therefore, the inquiry 
should be, whether either, or both of these, necessarily take 
place from pregnancy? We know of no absolute reason why 
pregnancy, abstractly considered, should render the milk of the 
woman who is giving suck unfit for the purposes of the child ; 
and, for this reason, we should be unwilling to test this subject 
by argument, simply because the question should be determined 
by facts alone. Now, these, so far as we have observed, do not 
declare positively either one way or the other ; for we have seen 
several instances where children were suckled with impunity 
until others were born ; and other cases, more numerous, where 
children were weaned at the usual time, though the mother was 
some distance advanced in her pregnancy, without the smallest 
injury having been done to the children so circumstanced; while 
others, again, were obliged to be taken from the breast at a very 
early period, in consequence of the injurious effects of deterio- 
rated milk. The rule, therefore, which we have for many years 
observed, is, if the milk disagree, let the child be separated; but, 
if it do not, let it be continued at the breast until the proper 
time of separation; or, at least, until some injurious effect mani- 
fests itself. 

630. No possible injury can arise from this plan ; for the mo- 
ther who may be thus circumstanced will be upon an anxious 
watch for the moment of injury ; and, therefore, will, the instant 
it is perceived, make other provision for her child. The symp- 
toms which may denote this state, are, on the part of the mo- 
ther, the diminution of the quantity of the milk; and on the 
part of the child, its aHered quality ; the latter will declare itself 
by being almost immediately rejected, and that in a state of hard 
curd; or in a thin, semi-transparent, condition, with a peculiarly 
disagreeable smell. 



172 OF WEANING. 

Sect. II. — On the part of the Child. 

631. When the child has arrived at the eleventh or twelfth 
month of its age, it is generally thought to be sufficiently ad- 
vanced to be taken from the breast. But it will immediately 
strike any one of reflection, that the rule formed upon the age 
of the child must be liable to many important exceptions. We 
shall, therefore, consider this subject under two distinct heads ; 
and these subject to those variations which the season of the 
year shall impose upon them. We shall, therefore, regard, 1st, 
the state of the teeth ; and, 2dly, the state of the health of the 
child. 

a— Of the Teeth. 

632. Nature evidently intended that the cutting of the teeth 
should have some meaning as well as use ; and in our minds, 
that meaning cannot well be mistaken, though she assumes much 
variety in the period at which this may happen. That the period 
of cutting the teeth is uncertain, is familiar to the observation of 
every body; yet, at whatever time this may take place, the cir- 
cumstance marks the condition of the stomach or of the digestive 
powers, in most cases, with much certainty. Thus, if a healthy 
child 1 cut teeth at four months, it is more than probable that its 
digestive powers would be as great as those of a child that might 
not protrude them until eight, or even a more advanced period; 
therefore, if it be proper, from the circumstance of teeth ap- 
pearing, to alter the nature of the food of the child, it must be 
so at the early as certainly as at a later period. That nature 
intended that these little instruments should be employed as soon 
as they make their appearance, is rendered more than probable, 
by their coming almost always through the lower jaw first. In 
this situation, they can be called into immediate requisition, when 
necessary, which is not the case when they appear first in the 
upper jaw. 

633. It would seem, then, that a child is capable of preparing 
its more solid food in proportion to the number of teeth it may 
have cut; and that precisely at the period at which they make 
their appearance. Therefore, the number of the teeth more 
certainly points out the powers of the stomach, than the period 
of the child's life at which they may show themselves. In con- 
firmation of this last remark, we may observe, that we have 
almost constantly noticed, that children who are late in cutting 
their teeth neither seem to crave solid food more, nor digest it 
better, than those who were much younger, but who were sup- 

1 We say, "if a healthy child cut teeth at four months," &c, for we have seen 
several instances of precocious dentition, in extremely debilitated constitutions — 
such, therefore, then, must be regarded as exceptions to the rule. 



OF WEAXIXG. 173 

plied with an equal number of teeth. And, again, we may re- 
mark, that the force of constitution is very well declared by the 
periods at which the teeth may be made to protrude through the 
gums. 

634. From these observations it will be evident that the rule 
founded exclusively upon the age of the child must be of very 
doubtful application, if not injurious in its observance, since it 
might sever a child from the breast at a time when its stomach 
was ill qualified to provide for the contingencies of the system. 
We should, therefore, say that the presence of teeth ii abso- 
lutely necessary to the success of weaning, let the age of the 
child be what it may; and, consequently, that this should never 
be undertaken until several are cut. 

635. Dr. Struve recommends that such children as may be 
suckled by a wet nurse should be weaned as early as at six 
months, lest their future affections be transferred from the mother 
to the nurse. We cannot see the propriety of this advice, since, 
if the mother pursue the plan we have already laid down, (610,) 
namely, to make the nurse the mere organ of nourishment, there 
13 but little danger of any permanent transfer of the child's 
affections. Besides, it is unquestionably much too young, at 
least in this country, for such a privation ; for the child, at this 
period, has not a sufficient number of teeth to masticate its food, 
or, at least, sufficient to declare the stomach capable of digesting 
it; or this period may arrive at such time of the year as we have 
already observed would be inconvenient or improper. Again ; 
he urges, as an additional reason for this early separation, 
that "the trouble attendant on weaning them is generally much 
greater after six months, when their mental powers begin t£ 
expand, and the power of recollection daily increases, so that 
they cannot, without great struggles, forget the foster mother, 
and her breast." P. 229. This apprehension is altogether chi- 
merical; at least, as far as regards any evil happening to the 
child. We have often witnessed such separations; yet we have 
never known any injury happen to the child, though they have 
not been taken from the breast until a much later period. But 
be this as it may, the benefit of the child's bodily health should 
be consulted, rather than this temporary affection of its mind. 

636. Indeed, Dr. Struve himself furnishes a most conclusive 
argument against his own plan, by declaring that "if the teeth 
should appear while these arrangements are taking place with 
respect to a new system of diet, the child must, without hesita- 
tion, be returned to the breast, till the first cutting of the teeth 
is effected by nature." P. 230. Is this not truly a work of 
supererogation? How seldom can it happen that the child must 
not be restored to the breast, if the period of six months be the 
age for weaning, and the appearance of the teeth the contra- 



174 OF WEANING. 

indication to this process ? Does not this decidedly declare that 
nature did not intend this separation until the child was in some 
degree prepared for it by the appearance of these little instru- 
ments ? We cannot hesitate a moment to believe this to be the 



case. 



I— The State of the Child's Health. 

637. It will, at first sight, be evident that the state of the 
child's health must have a decided bearing on the propriety of 
weaning, at the moment it may be proposed to be carried into 
effect; for the child may be much reduced by previous illness, 
or labouring under actual disease, so as to render this privation 
highly injudicious. If in the former condition, no nourishment 
at the moment can be so proper, perhaps, as the mother's milk ; 
or so certainly and freely conveyed, as by the mother's breast ; 
and when nourishment is all-important to the recovery of the 
child, as it very often is, it would be highly cruel, if not criminal, 
to withhold the breast from it — therefore, weaning, as a matter 
of choice, must not be thought of at this time. For in the latter 
condition, breast milk may be the only nourishment proper to 
give. If so, it should be retained for this useful purpose. Be- 
sides, the experiment of taking away the breast while the child 
is actually ill, has always been attended by bad consequences, 
even where, at such times, it has spontaneously weaned itself; 
therefore, it should never be attempted at that time, as a matter 
of choice. 

Sect. III. — Of the Season of the Year. 

638. It is a fact so well known that it scarcely requires men- 
tion, that the period of the year will much influence a decision 
on the question of weaning. The season of the year may render 
this act convenient, inconvenient, or improper. 1st, The con- 
venient season of the year will be all that period when its tem- 
perature is moderate ; as the months of March, April, May, 
June, October, or even early in November ; when the nights are 
neither excessive in length nor the atmosphere severe in tem- 
perature. 2dly, It may be inconvenient from both these last 
named causes, in the months of December, January, and Feb- 
ruary. 3dly, It maybe improper, in case of diseases arising from, 
or incident to, a certain part of the year ; being always aggra- 
vated in newly weaned children; as in the months of July, 
August, and September. Therefore, weaning should be in part 
regulated by these considerations. 

639. When weaning has been determined on, and rendered 
proper by the condition of the child, it will in a great measure 
be prepared for this process beforehand, if it have been properly 
attended to, by having occasionally received other nutriment 



OF WEANING. 175 

than the mother's milk. The task is then, in part, performed; 
and the whole of the trial may be rendered less severe by the 
observance of the following rules : — 

640. 1st. Accustom the child, from time to time, to take other 
food than its mother's milk, by feeding it on bread and butter, 
bread and milk, rice and milk, &c, or occasionally on beef, 
mutton, chickens, or oyster tea ; or, by giving small quantities 
of either of these substances, in a solid form, as has already been 
directed. 

641. 2dly. Let the mother give the breast at longer inter- 
vals, and gradually prevent its being the principal support of 
the child. 

642. 3dly. Let the child, after a little longer time, receive 
the breast as seldom as possible. 

643. 4thly. Endeavour to excite aversion to the breast, and 
thus induce the child to withdraw itself from it, rather than 
permit it to feel the want of it a privation. 

644. 5thly. This aversion may be excited in one of two ways — 
either by touching the nipples with some bitter or disgusting 
substance, as aloes, garlic, assafcetida, &c, or covering them 
with a forbidding one, as black wool, ink, court-plaster, &c. 

645. 6thly. "When you commence this severe process, be firm, 
and let no importunity of the little pleader overcome your reso- 
lution, or your work will never be finished. 

646. The process of weaning is much facilitated by accustom- 
ing the child for some time to the use of vessels from which it 
may drink any nourishing fluid, or even water at first. When a 
cup or glass is presented to them, their curiosity is immediately 
excited, and they at once express their eagerness to possess it, 
by stretching out their arms, and seizing it with avidity; and no 
sooner are they in possession of it, than they carry it to their 
mouths. By taking advantage of this early propensity, children 
may soon be taught to receive food from almost any vessel that 
may be offered to them. This plan, however, requires one cau- 
tion — should the child have teeth both above and below, it may 
be dangerous to trust them with vessels of either glass or china — 
some metallic utensil will be much better. 

647. A great error is generally committed, immediately after 
weaning, by giving the child not only too much food, but that of 
too gross and too solid a quality. This injurious practice has 
arisen from the supposition that the child not only requires it, 
but that it is certainly capable of digesting it. This plan of 
treating children at this timeis replete with mischief; and this 
mischief is commensurate with the tenderness of the child's age, 
and the solidity and grossness of the food exhibited. It injures 
the tone of the stomach by overloading it; and its digestive 
powers are destroyed by the severity of the duty imposed upon 



176 OF WEANING. 

them ; in consequence of which the child falls away, and becomes 
weak in proportion as the plan is insisted on. If there be any 
latent tendencies to scrofula, rickets, or consumption, they are 
now actually developed, and the child falls a victim to the- over- 
weening desire of the mother or its friends to promote its wel- 
fare. 

648. Where milk will agree, there is no food so proper after 
the child is taken from the breast. It may be employed in any 
of its combinations, with good wheaten bread, rice, sago, &c, 
only remembering, when any of these articles is found to agree, 
it should be continued perseveringly, until it may become offen- 
sive; in this case, some other combination may be required. 
Or, should the child be pretty well supplied with teeth, it may 
be occasionally aided by small quantities of either of the animal 
juices already mentioned; but subject to the restrictions then 
suggested. Struve recommends, on the authority of Hildebrandt, 
a soup made of the yelk of eggs and well-fermented strong beer. 
As well as we can understand his limited direction, it is made 
in the following manner : two or three yelks of eggs are well 
beaten together, and gradually added to a quart of beer by 
briskly stirring it, to prevent curdling; it is then to be well 
boiled, and sweetened to the taste. Of this the child may take 
small portions several times in the day. 

649. It now and then occurs that neither cow's milk, nor any 
other, in its unaltered form, will sit upon the stomach of a child 
when attempts have been made to rear it by artificial means. 
"When this happens, we have substituted, with great advantage, 
gum Arabic, in solution, in the proportion of an ounce to the 
pint of water: to this must be added a little sugar, and as much 
milk as will colour it, if the child be old enough to observe it. 
Or, we have recourse to rennet whey, a little sweetened, and 
disguised, if necessary, as just stated. When neither of these 
succeeded, we have substituted the weak animal juice, as before 
recommended. 

650. Dr. Clarke 1 recommends, under such circumstances, some 
farinaceous decoction mixed with a little cream. Of this we can 
say nothing from our own experience — nor are we aware to what 
farinaceous substance he alludes, but suppose that either sago, 
tapioca, or arrow root, might produce the desired effect. 

651. In the midst of our care for the child, we should not 
forget that which may be necessary for the mother or the nurse; 
for if proper management be not made use of at this time, she 
may suffer much from the swelling of her breasts. To prevent 
this, it may be well, especially with one who has an abundance of 
milk, that she begin to moderate it, as soon as she commences 

1 Commentaries., p. 57. 



OF TEETHING. 177 

with the preparative steps of weaning, by eating and drinking 
less, and not having the child so frequently placed to the breast. 
652. If these directions be duly attended to, the nurse will 
not experience much inconvenience from accumulated milk. 
But with a healthy woman, at whatever period almost she may 
remove the child, there will be a painful distention of the breasts : 
for the relief of which, let her observe the following precautions : 
1st. After the child is separated, she should abstain as much as 
possible from all fluid nourishment, eating nothing but the driest 
food, as crackers, boiled rice, potatoes, boiled meats, or poultry. 
2dly. Let her avoid all salted articles, as they will increase thirst 
and oblige her to drink. 3dly. Let her drink nothing but pure 
water, and that in small quantities. 4thly. Let her take a brisk 
dose of salts, if the pain in the breast be considerable, and avoid 
exercise as much as possible. 5thly. If the breasts be very 
much distended, and painful, rub them with a little warm sweet 
oil, or fresh hog's lard. 6thly. Let the breasts remain without 
drawing as long as it may be supportable; and when drawn, let 
it be only in such quantity as shall remove the distention. 7thly. 
Let the intervals of drawing be each time longer. 



CHAPTER VIII. 



OF TEETHING. 



653. In treating this subject, we do not think it necessary to 
enter into minute anatomical descriptions of the first formation, 
the progressive development, and successive changes which the 
teeth undergo, before they are protruded through the gums ; 
we shall, therefore, confine ourselves to a brief description of 
the arrangement and order that nature pursues in accomplish- 
ing tlii important and oftentimes hazardous process. 

654. The teeth are formed, in part, in the foetus; especially 
the deciduous teeth. They are confined in distinct apartments, 
or sockets; the first being placed above the second or permanent 
set. The first set consists of four incisors in each jaw; two 
canini, or dog's teeth, and four grinders ; making twenty alto- 
gether — that is, 

Eight Incisors, or cutters ; 

Eour Canini, or dog teeth, or stomach, or eye teeth ; and 

Eight Molars, or grinders. 

Qod. It is the teeth passing through the gums that creates the 
pain and disorders of teething, by stretching their investing 
membranes; or, in other words, the tooth augments in size faster 
12 



178 OF TEETHING. 

than the parts which enclose it are removed or absorbed. The 
cutting of the first set generally commences about the sixth or 
seventh month, and ends between the second and third years. 
These teeth are always smaller than the permanent set, with 
the exception of the bicuspids, or small grinders. This is a wise 
provision of nature, as the jaw enlarges, even to near the adult 
age; consequently, as the jaws should have both their circular 
portions filled, the teeth must be proportionally larger as age 
advances. 

656. The order of cutting is, generally, as follows : — first, the 
two middle incisors of the lower jaw; then, after an interval of 
three or four weeks, the corresponding upper incisors follow; 
but, frequently, the whole four appear in the upper jaw before 
the two lower ones are protruded. The two lower canine, one 
on each side, now declare themselves ; and these are followed by 
their corresponding teeth in the upper jaw. Soon after this, the 
first two grinders, one on each side, succeed the canine in the 
lower jaw; those above then follow. 

657. After a lapse of from four to six years, four more 
grinders are added to each jaw; these are permanent. At the 
age of twenty-one, four more teeth are given, and are called 
dentes sapientiae, or wisdom teeth. 

658. It must, however, be recollected, there are many remark- 
able as well as curious deviations from the order just related, 
some of which it may be interesting to mention. 

659. 1. Sometimes children are born with teeth ready cut; 
but this precocity is no proof of vigour of constitution. 1 

660. 2. Sometimes the lateral incisors cut themselves before 
the middle ones ; at other times the canine may be seen before 
the incisors. 2 

661. 3. It is now and then observed that the teeth are very 

1 We have witnessed but two instances of children being born with teeth. We 
had the first opportunity in the year 1798, and the second in July, 1829. In this 
case, there was but one tooth; but which, to this time, (July, 1830,) remains 
fixed, and is still solitary. This tooth appears to have all the characters of a 
milk tooth. There were two teeth in the first instance, and, being the middle 
incisors of the lower jaw, were very troublesome to the mother from their sharp- 
ness; and very painful to the child, from their not being firmly set in the jaw; 
they could easily be moved backward and forward, in consequence of which the 
gum became irritated and inflamed. We cut them both out without the smallest 
difficulty, as they had no roots, nor did they appear ever to have had — they were 
loosely placed in the ridge of the gum. We do not believe these teeth were ever 
placed in the alveoli of the jaw — they seem to be the product of the gum itself. 

There are several instances upon record of this kind. Louis XIV. of France, 
and Richard III. of England, are said to have been born with teeth. They do not 
appear to be of the smallest use to the child, but are, on the contrary, perhaps, 
mischievous. Children of this description are said to be less firm in constitution 
than those who cut their teeth at the regular period — they generally die before 
the third year. In one of the cases we witnessed the child died in its fourteenth 
month: the other is quite young. 

3 Diet. Scien. and Med.," art. Dentition. 



OF TEETHING. 179 

tardy in showing themselves. We have several times seen the 
first tooth make its appearance after the fourteenth month; and 
Van Swieten mentions an instance where this did not happen 
until the eighteenth month, though the child was perfectly 
healthy; 1 and a child is now under our care who has not yet cut 
a tooth, though rather more than seventeen months old. 

662. 4. Bayer mentions a case where the four canine teeth 
did not show themselves until the child was thirteen years old. 
This case was attended by severe headache, sore eyes, and con- 
vulsions, for eight days previously to their appearance. 2 

663. 5. Fouchard relates an instance, where, at six years old, 
the child had none but the fore teeth. 3 

664. 6. Brouzet gives an instance where only one-half of the 
proper number of teeth were present at the twelfth year of the 
child's life; and whose gums had acquired the hardness of an 
old person. 4 

665. 7. Professor Baumes gives the history of a man who 
never had any teeth to appear. 5 

666. At the time of birth the teeth are lodged, as mentioned 
above, in separate compartments; the deciduous and permanent 
ones having their respective stations within the cavity of the 
jaw bone, and placed over one another. Each tooth is, at first, 
but a pulpy substance, and acquires hardness as the foetus be- 
comes older; the crown hardens first, the root then becomes 
ossified, and is hollow, that it may have transmitted into its sub- 
stance blood vessels, and a filament of nerve. 6 

667. The whole tooth is surrounded by a delicate, sensible, 
and vascular membrane, which may be considered as its perios- 
teum. This membrane is put upon the stretch — if not regularly 
absorbed as the tooth increases ; (655) hence the pain and in- 
flammation which so frequently accompany dentition ; and upon 
the division of this membrane depends the relief so often expe- 
rienced by incising the gums. 

Sect. L — Phenomena of Dentition, 

668. 1st. One of the first signs observed in a child about to 
cut a tooth, is heat in its mouth, which is distinctly perceived 
by the delicate and sensible nipple of the mother. This heat 
produces thirst, and makes the child demand the breast more 
frequently than before. An itching, most probably, accompanies 
this condition of the gum ;-as the child, with a view to relieve it, 
seizes the nipple, and strips it frequently, by pressing its little 

'Diet. Scien and Med., art. Dentition. 2 Ibid. a Ibid. 4 Ibid. 5 Ibid. 

6 Mr. John Hunter, however, says, he never could trace the nerve distinctly, 
even to the beginning of the cavity. The nerves supplying the teeth are derived 
from the second and third branches of the fifth pair. 



180 OF TEETHING. 

jaws closely upon it: it also rubs its mouth with its fingers, and 
presses upon every substance offered to its gums, however hard 
that substance may be. In proportion as the child acquires age 
before it cuts a tooth, is this disposition to press upon any thing 
placed between its jaws ; hence, the mother is very often made 
to suffer by severe pressure upon the nipple. 

669. 2dly. A slavering, or a slight salivation, almost con- 
stantly accompanies this condition of the gums, and seems in- 
tended for four distinct purposes — first, to diminish by this dis- 
charge the inflammation and irritation of the gums; secondly, 
to moderate the thirst consequent upon this local inflammation, 
as the child is observed to demand the breast less frequently 
after this takes place; thirdly, to supply an additional quantity 
of saliva, with a view to assist digestion, as the stomach and 
bowels are apt to become disordered by too much food, or by its 
remaining too long undigested; hence, children who slaver much 
are more rarely affected with bowel complaints than those who 
do not run at the mouth; fourthly, it serves as an evacuant, 
thereby abating the general vigour of the arterial system, which 
too frequently is roused into inordinate action by the process 
of teething. 

670. 3dly. After these symptoms have continued a longer 
or a shorter time, the gum is observed to become redder, a little 
swelled, and immediately over the points at which the teeth are 
about to issue, we may frequently observe, in the lower jaw, the 
parts to be semi-transparent; these points are small cells, and 
very often contain a little effused serum between the edges of 
the teeth and the external covering of the gum. At these points, 
we may also observe the little thread-like ridge to be effaced, 
which mounts the centres of the gums, before any swelling takes 
place, and the teeth soon after pierce the gum. 

671. 4thly. The membrane lining the nostrils very often be- 
comes sympathetically affected; hence the frequent rubbing of 
the nose, even to abrasion, sneezing, &c. 

672. 5thly. Fever of a slight kind is very often provoked. 
This shows itself by heated palms ; highly coloured, and often- 
times offensive urine ; flushing of the cheeks, frequently, how- 
ever, but one at a time; great dryness of the lips, and heaviness 
of the eyes. 

673. 6thly. If several teeth are about to appear together; if 
the absorption of the gums do not proceed regularly; and if the 
system be naturally irritable, we find the salivation either ex- 
cessive, or nearly arrested; the gums, too, become much swollen, 
very red, somewhat spongy, and extremely sensible ; fever, even 
excessive at times; the kidneys furnishing much urine, 1 leucor- 

1 Sometimes this secretion is entirely arrested, much to the risk of the child — 
when this happens, immediate attention should be paid ; the child should be placed 



OF TEETHING. 181 

rhcea in females ; impatience, fretfulness, frightful dreams, start- 
ings in sleep; laughing or whimpering while dozing; diarrhoea, 
more or less violent ; swelling of the submaxillary glands ; sore, 
or tender eyes, 1 and convulsions. 

674. Though these symptoms but too frequently accompany 
the act of teething, they are by no means constant. We some- 
times see them much more moderate than above described; some 
one or two only of these symptoms appearing together; and they 
not alarming; and, again, the whole of the teeth may make their 
appearance so regularly and silently as not even to attract 
notice. 

675. The process by which the teeth appear above the gums, 
or, as it is commonly called, " cutting of the teeth," is not ge- 
nerally well understood, especially by mothers. It is looked 
upon, altogether, as a mechanical process ; whereas, it is only 
partially so. We shall, therefore, describe the manner in which 
this takes place, as it is important that this process should be 
well understood. 

676. The teeth gradually enlarge within their respective 
sockets. This increase is in three different directions — first, 
upward, so as to press against the investing membrane and in- 
cumbent gum, and thus induce their absorption — secondly, cir- 
cularly, so as to impinge upon the edges of the sockets: this 
pressure, when it becomes very strong, destroys the circulation 
in the membrane which is fastened to the neck of the tooth, so 
as to kill it, and thus occasions its absorption — thirdly, down- 
ward; but the depth to which the root sinks is limited by the 
under part of the jaw. 

677. From these facts it will be perceived that the act of 
cutting teeth is but in part mechanical; but that part is of great 
consequence, since it gives rise to that important physiological 
function called absorption. It is generally thought that the 
teeth force their way through the resisting gum, but this is not 
the case, in the strict meaning of the word forcing — for the 
pressure of the tooth below stimulates the absorbents to take 
away the interposing membrane and gum, that a passage may 
thus be effected for it as it approaches the surface. 

678. The belief that the teeth force themselves mechanically 
through the gums, gave rise to the practice of employing coral, 
and other hard substances, to aid the operation. This practice 
has been praised as rational by some, and condemned as injurious 
by others. Those who have praised it have done so upon a 

in a warm bath and a few drops of sweet spirit of nitre be given, and repeated 
every bour or two until the child is relieved. Ten drops, or more or less, accord- 
ing to the age of the child, will be sufficient. 

1 The two last-named affections are easily accounted for, as the teeth, maxillary 
glands, and eyes, in part, derive their nerves from the fifth pair. 



182 OF TEETHING. 

wrong principle ; while those who have condemned it have done 
so with no better information. 

679. Nature herself seems to call for this practice. This 
seems to be proved by the disposition all children have to press 
upon every thing hard or resisting that is presented to their 
mouths, from the moment dentition begins, to its final accom- 
plishment. It is but complying with an instinct, from which 
they appear to derive both comfort and benefit, and it is as 
constantly obeyed as the necessity is created. Is this desire 
to press the gums upon every thing hard a proof of the mecha- 
nical nature of cutting teeth, as insisted upon by the advocates 
of the coral, by presenting the part to be pierced between two 
resisting substances ? We think not : though we are advocates 
for the employment of certain substances for the purpose of 
pressure. 

680. We are of opinion that the following advantages are 
derived from indulging this instinct in children : 1st, it relieves 
the pain or anguish of the tender gums, by pressing upon them, 
as squeezing an inflamed finger, as in felons or whitloes, and in 
many other instances; 2dly, by gently stimulating the gums, 
absorption is unquestionably promoted, and the teeth, in conse- 
quence, more quickly appear; 3dly, it seems constantly to pro- 
mote the salivation by which the engorged vessels of the mouth 
relieve themselves. 

681. The nature of the substance presented to the gums, as 
well as its shape, are not matters of perfect indifference, as it is 
generally supposed. For instance, the coral, which is always 
round and very hard, is improper, because the surface presented 
to the gums, in consequence of this roundness, is very small, 
and is thus calculated to do injury by its partial pressure, and, 
from its extreme hardness, to bruise the gum. We do not object 
to the coral, or other very hard substances, upon the principle 
generally urged by those who condemn their use; namely, " that 
they harden the gums, and thus prevent the tooth from coming 
through, or, at least, that it increases the difficulty of its pas- 
sage;" for we do not believe they "harden the gums," as it is 
called ; but that they are calculated to bruise these parts, increase 
their inflammation, and thus retard the process of absorption. 1 

682. The substance offered to the gums for the purpose of 
biting upon, may be of inferior hardness to the coral, ivory, &c. ; 
such as a piece of orris root or scraped liquorice root; but what 
is safer, a flat ivory ring, or a piece of India rubber. The rub- 

1 The process of dentition is one sometimes of difficulty among savage nations; 
as we are informed that among the Dacotas, "the children suffer much. In such 
cases, the gum is never cut, but the children are allowed smooth stones, and other 
hard substances, to rub against their gums." — Long's Second Expedition^ Vol. I., 
p. 312. 



OF TEETHING. 183 

bing of the gums with the finger affords great relief when they 
are much irritated; and we constantly recommend this pleasant 
application. But we decidedly disapprove of any such substance 
as honey, powdered sugar-candy, &c, being employed for this 
purpose, as they only serve to irritate the gums, without further- 
ing the object for which they are employed. The shape of the 
substance on which the child is to bite should be nearly flat, 
and sufficiently broad, that it may present a large surface to the 
gums : it should, also, be of the proper thickness. 

683. There exists a diversity of opinion on the propriety of 
aiding the protrusion of the teeth, by cutting through the swollen 
gums. We are, however, of opinion, there should be but one, 
and that should be in favour of the operation. We shall again 
consider this subject, when treating of the diseases which may 
accompany teething. See Diseases of Teething, Book II. 

Sect. II. — Second Dentition. 

684. At about the seventh year, the deciduous, or milk-teeth, 
are replaced by others of a larger and more permanent kind. 
The first teeth are almost always very perishable, and rarely 
last in a perfect state until the jaws are supplied by the second 
crop. They are very apt to decay, particularly with children 
of feeble constitution, or who have been much afflicted, by sick- 
ness. The incisors are particularly liable to caries, especially 
those in the upper jaw — they frequently turn black, and break 
off close to the gum. The larger teeth are also disposed to 
caries, and often create much suffering by their decay. We 
have, however, never observed these inconveniences to influence 
the second cutting of teeth. 1 Indeed, sometimes, it would seem 
to favour their growth, by offering less resistance to their pas- 
sage. 

685. Parents very frequently neglect their children's mouths, 
at this period of life, to the serious disadvantage of their future 
comfort, especially when the front upper teeth are labouring 
under decay. Against this inattention we would wish to warm 
them, by recommending the removal of the stumps of teeth, 
whenever they ache, or the gum becomes inflamed, or the tooth 
becomes loose. If the early stage of this inflammation be neg- 
lected, the coverings of the teeth are almost sure to inflame, 
and run on to suppuration. Gum-boils are formed, and the 
roots of the teeth find their way through the gum by the sockets 
being absorbed in which they were confined — in consequence of 
this, the teeth, which are to follow, receive an injury, for the 
want of due protection from the plate of bone in front of them, 

1 This will be readily understood, when it is recollected that each set is con- 
tained in separate apartments. 



184 OF TEETHING. 

which was too suddenly removed. It is, therefore, every way 
desirable and proper, that they should be removed in good time 
by a skilful dentist. The same observations will apply with 
equal propriety to any other of the teeth that may be painful, 
or that may have the gum surrounding them threatened by 
abscess. When the teeth are much decayed, and the time is 
approaching for the appearance of the permanent ones, the 
child's mouth should be examined, or, rather, submitted to the 
judgment of the dentist. 

686. Before, however, the time for the second cutting arrives, 
the child undergoes very considerable changes in its person. 
This change happens generally after the second year; that is, 
very soon after it has completed its first dentition. The jaws 
are now observed to spread themselves, and to acquire an in- 
crease of strength, since at this time they can break down with 
the teeth pretty hard substances. 

687. The fontanelles are generally closed, or, rather, the soft 
cartilage with which they were before covered is now converted 
into bone of greater or less hardness. The limbs acquire an in- 
crease of power, and the child walks with more firmness and 
assurance. The abdomen loses its roundness, and becomes more 
flattened 

688. The face becomes more expressive, the eyes acquire more 
intelligence, and the whole features of the child are better deve- 
loped; this is particularly the case with the nose, which now 
assumes its permanent form. The chin becomes rounder, and 
gives more freedom to the teeth within. The internal viscera 
augment with the other portions of the body ; and the senses 
become more accurate in their several discriminations. The 
tongue gradually gives utterance to words ; and they quickly 
acquire the power of expressing their little wants. They thus 
obviously improve until the seventh year ; at this time the first 
teeth gradually drop out, to give place to another set — this 
operation is called shedding the teeth. 

689. We have already observed that the first teeth are but 
twenty in number : these are now replaced by twenty-four. At 
about the twelfth or fourteenth year, four more are added; and 
the teeth of wisdom follow at from the eighteenth to the thirtieth 
year. 

690. We have also observed that it is commonly supposed the 
first set of teeth are pushed out mechanically, by the second 
rising under them ; but this is not the case, for the following 
reasons — 1st, because the first and second set are not contained 
in the same cavities or sockets, nor are they immediately opposed 
to each other by situation ; 2dly, because the first set does not 
rise in proportion to the advance of the second, which would be 
the case were they lifted from their position by the second set; 



OF TEETHING . 185 

3dly, because there is a destruction of the sockets of the first 
teeth, while those of the second remain perfect, and increase in 
size; 4thly, because some of the first set fall out when there are 
no second ones under them; othly, because the roots of the first 
set are almost always observed to be removed by absorption, so 
that the teeth are now only fixed by their necks to the gum, and 
can be easily moved in any direction, or have become loose. 

691. The reason for shedding the teeth must be obvious to 
any one who will give the subject due consideration. In the 
infant, the jaw is so small, when compared even with that of a 
child of seven years, that much inconvenience would be expe- 
rienced, did not larger, and a greater number of new teeth supply 
the place of the first; a fortiori, the inconvenience would be 
greater in the adult, did not these useful little instruments occu- 
py a larger space. For, were the grinders of the child to be 
the last to be provided, they would, by the growth of the jaw in 
adult age, be thrown so much in advance as to be almost useless, 
by being removed from the centre of motion. 

692. From what has been said it will be evident that the first 
and second sets of teeth are nearly independent of each other; 
that is, the condition of the first set has little or no control over 
the second, and the reverse. 

693. The order in which the second set appears is pretty 
nearly the same as that of the first — the incisors first show 
themselves, and are oftentimes much larger than those of the 
first set, but the first permanent grinders do not usually appear 
until about the twelfth year, the second about the eighteenth, 
and the teeth of wisdom from the twentieth to the thirtieth year, 
as has been already noticed. So that the incisors, and the cus- 
pidati, require about six or seven years from their first appear- 
ance, to arrive at perfection; the bicuspids about seven or eight ; 
and the molars about twelve. 

694. The increase of size, and the augmented number of the 
second teeth, sometimes do not find sufficient room in the jaws 
to arrange themselves in regular order. When this happens, 
some of the teeth are obliged to be extracted — but this is the 
business of the dentist. 



186 OF THE FOOD PROPER FOR CHILDREN 



CHAPTER IX. 

OF THE FOOD PROPER FOR CHILDREN AFTER THE FIRST DENTITION 

AND WEANING. 

695. It must not be imagined that every kind of food is proper 
after the child has completed its first dentition. For, though 
this important change has been successfully accomplished, still 
the digestive organs require that only such substances shall be 
offered as can be completely and readily subdued by the still 
feeble teeth. It would, on this account, be highly injurious to 
feed the child upon such food as would require great powers of 
mastication, as it would neither have strength nor patience to 
reduce it to sufficiently small particles ; it would, therefore, be 
at the risk of choking, swallowing it whole, or having it con- 
veyed into the stomach very imperfectly chewed. 

696. The stomach would thus receive food not adapted to its 
powers, and, of course, would suffer by its being improperly 
taxed. But it is not the quality of the food, alone, that is to 
be attended to when a change is contemplated — we should be par- 
ticularly careful that this change be not made too suddenly. The 
stomach, during almost every period of life, seems to acquire, 
from habit, a power over substances of even an indigestible kind ; 
and is capable of converting them into proper nourishment, when, 
perhaps, it might fail in subduing some other, which, generally, 
is of more easy solution. Therefore, a part of the food, at least, 
that was given during suckling, may be continued with much pro- 
priety after weaning. 

697. It must, however, be recollected, that an additional quan- 
tity will be required, since the child now loses a part of its former 
sustenance by the abstraction of the mother's milk. This may 
be accomplished in one of two ways: first, by increasing the 
number of meals; or, secondly, by augmenting the quantity at 
a meal. The last method is preferable, since it permits a longer 
interval for the digestion of the quantity previously taken ; for, 
as we have already observed, the process of assimilation should 
not be interrupted, when it can be avoided, by additional quan- 
tities of food being poured into the stomach. 

698. On this account, it is always important to establish re- 
gularity in meals ; but, for the child newly weaned, the periods 
which were formerly observed in suckling may, for awhile, be 
retained; taking care to prolong the intervals gradually, that 
they may, after a time, be reduced to an orderly series. We 
would not wish, however, to lay down absolute rules for this pur- 



AFTER THE FIRST DENTITION. 187 

pose, since the intervals must in a great measure be contingent 
upon the powers of the stomach itself; and these must neces- 
sarily vary in different children, some digesting much more rapidly 
than others, owing to the original healthiness of this organ, or 
to circumstances connected with air and'exercise. Thus, children 
running about in the pure air of the country will digest their 
food more rapidly than those confined within the walls of the 
nursery, and who breathe the less pure air of the city. 

699. There is, perhaps, no period of the child's life in which 
so much care is required to avoid overtaxing the powers of the 
stomach. It is at this time, particularly, that the foundation of 
a weak stomach is laid, by giving too much food, even of a good 
quality; but, more frequently, by indulging children in such ar- 
ticles as their little stomachs cannot master. Many parents are 
of opinion that children should be indulged in whatever they 
fancy — believing, most erroneously, that this organ never craves 
that which would be hurtful to it. Hence, the preposterous and 
injurious farrago with which children are sometimes crammed; 
and hence indigestion, with all its terrible consequences. 

700. The food of children cannot well, at this period, be too 
simple. A great mixture is bad, in every stage of life ; but is 
particularly injurious in infancy, and in childhood. The various 
jellies from vegetable substances, at this time, are very proper 
— such as the jellies of tapioca, rice, sago, or arrow root; these 
may be taken with fresh milk, with the most decided propriety 
and advantage, since they are void of all stimulus, and are of 
easy assimilation. The quantity of these, however, must be re- 
gulated by the good sense and discretion of the parent, rather 
than by the appetite of the child; for this may be naturally in- 
ordinate, or artificially so, by ill-judged indulgence. 

701. During the period of dentition the system is almost 
always in a highly excitable state, and is but too readily roused 
into fever ; therefore, nothing can be more decidedly preposte- 
rous and destructive than allowing children to live upon stimu- 
lating articles of food; yet nothing is more common. Parents 
cannot always resist the importunities of their children, though 
their better sense at the moment condemns the indulgence; and 
thus a habit of importunity is created, and in a short period they 
permit themselves to be governed; and the children in conse- 
quence are rendered miserable by a compliance with their arti- 
ficial wants. 

702. It requires only a little firmness in the beginning, and 
that not of very long continuance, to make children conform to 
the dictates of their parents, and to render them entirely obe- 
dient to their wills : for it is only necessary to commence suffi- 
ciently early, to make the child know it is not to think for itself. 
Neither its palate nor its caprice is to be consulted — the parent 



188 OF THE FOOD PROPER FOR CHILDREN 

must set before it, for its meals, such articles of food as are 
judged best for it; and it is to be made to understand that it 
must eat them, or nothing. If this plan be followed for a short 
time, all trouble will cease; since, as the child has never had a 
wish respecting its food gratified at the expense of propriety, it 
•will soon cease to have any; or rather, it will never have any to 
arise. But if the parent be weak enough to consult the child's 
taste at the table, it will soon demand a portion of every dish, 
nor be satisfied until it obtain it. We need not say how sub- 
versive this conduct would be of all order and propriety ; or how 
seriously, nay, oftentimes, how irreparably, the child may be 
injured by it. 

703. We must not, however, be understood to prohibit all in- 
dulgence to a child at table ; on the contrary, we would wish to 
make them feel, every now and then, that we are doing them a 
favour, by occasionally departing from our general rule; taking 
care, at the same time, however, that we give nothing injurious 
to the stomach. By this plan they will perceive their depend- 
ence; and we also make them grateful for the occasional indul- 
gences they experience. 

704. This mode of treating children has many decided advan- 
tages over that of a compliance with the indiscriminate and often- 
times injurious demands they make at table. Their moral as well 
as physical powers are benefited by not yielding to their impor- 
tunities ; for if these be once complied with, there is an end to 
all future subordination — all control ceases, and health suffers 
almost in proportion to indulgence. How often does it become 
essential to confine children to specific diet? But how can this 
be effected, if they have been permitted to select their articles 
of food? Let any parents who have allowed their children to 
eat indiscriminately of any or every article at the table, answer, 
whether it does not constitute one of their most difficult tasks to 
withhold from them the prohibited articles when they become 
sick? Our experience declares it to be a common acknowledg- 
ment, that it is next to an impossibility to do so, however im- 
perious the necessity for such denial may be. Yet all this trouble 
might have been spared, if a proper system had been in due time 
adopted. 

705. It is not necessary to confine children always to the same 
form of food; this may be occasionally varied with advantage, 
especially if it be perceived that their appetites flag a little from 
the long continuance of one kind. Thus, milk, which should con- 
stitute the chief article of diet of children until after complete 
teething, may be given in a variety of very acceptable forms; 
such as milk and bread, boiled or unboiled ; rice and milk, sago 
and milk, arrow-root and milk, &c. Plain rice pudding is a 
very acceptable dish to almost all children, and may be occa- 
sionally introduced as a " bonne louche," with great advantage. 



AFTER THE FIRST DENTITION. 189 

706. We do not hesitate, also, to indulge children, now and 
then, with small quantities of animal food, especially after they 
have their first teeth complete. But animal food should not 
constitute their principal support even at this time, since it may 
overtax the stomach, and too much excite the system ; and before 
this time it should be most sparingly indulged in, though not 
altogether withheld, for the reasons assigned above. 

707. The drink of children should be pure water, or occasion- 
ally, milk and water. 1 There can be no possible propriety in 
giving them liquors of any sort whatever; for unless as a remedy 
in disease, the system never requires them ; and when indulged 
in without a necessity are sure to do mischief. But children 
should not be permitted to acquire a habit of drinking very often ; 
for it will certainly be mischievous, by over-distending the sto- 
mach, too much diluting the gastric juices, and impairing the 
nppetite. During their meals, a moderate quantity should be 
given to them, as it will then be useful by forming a more com- 
plete pulp of the food taken in, and thus subserve the purposes 
of digestion. The water given to children should not be of too 
low a temperature, lest it give pain, and do injury to the powers 
of the stomach. We think we have seen serious injury result 
from the too free use of iced water. 

708. It will readily be perceived that after the child has com- 
pleted his first dentition, he may b£ permitted, by a gradual 
change, to eat food of a more nutritive land — or, in other words, < 
more animal food. But in permitting this, a proper regard 
should be paid, first, to the kinds of animal food; secondly, to 
the mode of preparing it; thirdly, to the period of the day at 
which it is taken ; and, fourthly, to the quantity employed. 

709. 1. Of the kinds of Animal Food. — It must not be as- 
sumed with too much facility that even a moderate quantity of 
any kind of animal food is equally proper. It is no longer a 
matter of conjecture, but one of very often repeated experiment, 
that there is much difference in the degree of solubility, if we 
may so term it, of animal foods ; and that which from long ob- 
servation has proved to be the most easy of digestion, should be 
the one generally preferred. On this account, beef, mutton, lamb, 
venison, fowls, turkeys, pheasants, partridges, &c, are to be pre- 
ferred to veal, pork, pig, geese, and ducks ; since it has been 
proved, by almost universal experience, that the stomach assimi- 
lates the former more easily. We are aware that this is not 
universally the case; but the exceptions only prove the rule. 
Therefore, when a child is at the age proper for indulgence in a 

1 We have found weak molasses and water not only a very acceptable drink, 
but a valuable one to such as have a tendency to constipation; children, therefore, 
may be occasionally indulged with it as a pleasant beverage, as well as a very 
mild and certain laxative. 



190 OF THE FOOD PROPER FOR CHILDREN 

portion of animal food, one of the first class enumerated should 
be employed. 

710. Yeal and pork are particularly unfriendly to the young 
and unconfirmed stomach; and should, therefore, never be se- 
lected for the diet of such children. We have known numerous 
instances of both these substances remaining undigested in the 
stomach for four and twenty hours, and sometimes even longer, 
and then thrown up, after having tortured the poor child with 
pain, fever, or colic, for several hours. The flesh of ducks and 
geese is nearly as bad as veal or pork, but not altogether so, 
especially if care be taken to separate the skin from the flesh. 

711. Fresh fish, boiled, of almost every kind, sits well upon 
the stomachs of children, when taken in moderate quantities, 
and at proper periods of the day; and even salt fish, in very 
small proportions, is sometimes very acceptable. 

712. Eggs, when not boiled hard, are easily assimilated by 
most stomachs : they rarely disagree when fresh; and when given 
in moderate proportions, especially in the morning, are highly 
nutritious. Nay, they sometimes form a valuable article of food, 
when beaten up with sweetened water, or milk and water, during 
convalescence. 

713. Salted meats of every kind are of much more difficult 
digestion than fresh, if we except pork. Ham is less injurious 
than the fresh pork ; but salted beef, salted venison, and dried 
'mutton, are of more difficult solution than when fresh. 

714. 2. The mode of preparing it, — It is a matter of great 
importance that meats of every kind should be properly pre- 
pared or cooked ; for if this be not attended to, the most whole- 
some may be converted into a temporary poison, by being ren- 
dered literally indigestible. For young children, plainly boiled 
and roasted are the best; and these should be sufficiently done, 
or, in other words, not too rare. Poultry and fish should always 
be thoroughly well roasted or boiled; but the roasting should 
not be carried to the dissipation of all moisture— nor the boiling 
to the falling to pieces of the article. 

715. Game and poultry may be treated after the same man- 
ner — either roasted or boiled, in a due degree. Some, however, 
are of opinion that beef, mutton, lamb, or venison, cannot well 
be too little done — hence many have these articles brought raw 
to the table, sometimes to undergo a second process ; while 
others go to the opposite extreme. We think the proper degree 
lies between these extremes. It is pretty generally agreed, 
that poultry, and certain game, as the pheasant and partridge, 
should be well done ; if from among the poultry we except ducks 
—the latter are generally preferred under-done. This, unques- 
tionably, improves their flavour ; but we are not certain that it 
is any advantage to the stomach. The skin of any meat should 



AFTER THE FIRST DENTITION. 191 

not be indulged in — it should therefore be carefully taken off 
before given to the child. The skin of the meat or of fowls fur- 
nishes too much azote, agreeably to modern chemistry. 

716. Fried, stewed, or highly seasoned meats, are always im- 
proper for children ; veal cutlets, stewed veal, fricassees, or ra- 
gouts, are always injurious, and should ever be avoided. The 
same should be said of every kind of meat pies. Broiled 
meats are less injurious than fried; especially beef, mutton, 
or venison. Poultry, treated after the same manner, is less 
healthful, and should not be as freely given as when roasted or 
boiled. 

717. 3. The Period of the Bay. — It is very far from being a 
matter of indifference at what period of the day the child re- 
ceives animal food. Of so much consequence is this, sometimes, 
that the same article may be either proper or injurious, as it 
may be given at one time or another. Therefore, as a general 
rule, a rule, indeed, admitting of but few exceptions, animal food 
should be taken only in the morning, or at noon; and, as an- 
other general rule, we should much prefer the latter, for the 
following reasons : 1st. The child, in the morning, from the pre- 
vious night's rest, has its system rendered very excitable at that 
time; therefore it should be confined to bread and milk, weak 
tea or coffee, 1 and bread and butter, mush, boiled rice, or any 
other mild food. 2dly. From the appetite at this time being 
rendered very keen, there is a risk that it will take too much, if 
animal food be added. At noon, the excitability of the system 
is a little worn down by exercise, &c. ; and at this time, the 
stimulus of a moderate quantity of animal matter may not only 
safely but profitably be indulged in. In the evening we would 
forbid it, as digestion will not be completed before the child goes 
to bed, and it may have its sleep much disturbed in consequence; 
or, it may sleep too soundly, from the stomach being oppressed 
by an over quantity of food, or by the blood vessels becoming 
too much filled. 

718. 4. The Quantity Employed. — Children should never 
make animal substances a principal part of their food until after 
the age of puberty. Before this period there should be a pre- 
dominance of either vegetables or milk. The vegetables, how- 
ever, should be properly selected, and but one kind should be 
used at a time, as mixtures of them are always less manageable 
by the stomach than when they are presented singly. The best 
vegetables are rice, potato,,spinach, asparagus, turnip and squash 

1 We mention weak tea or coffee from necessity, and not choice. In our large 
cities, it is not always easy to command the more suitable article, milk. But 
any injurious qualities appertaining to either tea or coffee may easily be counter- 
acted ; or, rather, they may be so diluted, by the liberal addition of milk or water, 
as not to be hurtful. 



192 OF THE FOOD PROPER FOR CHILDREN 

— the less proper are, beans of every kind; cabbage, beets cooked 
with vinegar, peas, sorrel, and cucumbers. Animal substances 
must be used but in moderate quantities, especially with children 
who go to school; for if it be made the principal part of the 
diet of such children, they are sure to be over-stimulated ; they 
become sluggish and drowsy, and thus incapacitated for study. 
Those children who make milk the principal part of their diet 
are always found to be the best students. The fatigue of study 
is much diminished by employing a mild, nutritious diet; since 
by this regimen the faculties become more acute, and the me- 
mory is strengthened. Children should never be fed to satiety ; 
this should be carefully watched, and the instant you perceive 
them beginning to play with their food, it should be removed. 

7 19. We may then consider it proper to employ a moderate 
quantity of animal food after teething, and the quantity may be 
gradually increased until the age of puberty. Of the period 
subsequent to this we have at present nothing to say. 

720. In regulating the diet of children, care should be taken 
not to force any particular substance upon them, after it has 
been found by fair and repeated trials to disagree. There is 
both cruelty and bad judgment in doing so. It is cruel, because 
the poor child is forced to swallow that which is disagreeable to 
it ; and bad judgment, because it is perpetuating a disgust, which, 
most probably, would have subsided, had it been let alone — for 
the stomach will oftentimes forget injuries, if not reminded of 
them by repetition. 

721. Great care, however, must be taken at this period of life 
that permanent dislikes are not formed against certain articles 
of food. Temporary disgusts are frequently experienced; and, 
if not counteracted, may degenerate into inveterate aversion, to 
the great discomfort of the individual. The management of this 
case is frequently a point of great nicety; for it requires a good 
deal of close observation and discernment to distinguish between 
a wayward prejudice and an actual disgust. The former, if in- 
dulged in too long, may be converted into the latter, and the 
latter may oftentimes, by judicious and well adapted means, be 
entirely Removed. 

722. Waywardness or prejudice should not be yielded to — a 
little well-directed firmness is almost sure to overcome it. It is 
always best managed by reasoning ; by representing the incon- 
veniences and sometimes disagreeable consequences, which may 
arise from indulging in such feelings; and by persuading them 
they would soon become reconciled to the article if they were to 
make proper trials to become so. 

723. Real aversion arises from a particular feeling of the 
stomach itself, and which is not always under the control of 
reason, however strongly exerted. This condition may arise from 



OF SUBSTANCES HURTFUL TO CHILDREN. 193 

a natural and inherent dislike to certain articles of food, the 
origin of which cannot he traced; nor can its cause be ascer- 
tained. One of the most frequent of this kind is that to mutton. 
Or, it may arise from some accidental circumstance, as taking 
too much of any certain article ; to this not being in a perfect 
state ; or from its being imperfectly cooked — nausea and vomiting 
are excited, and the stomach becomes irreconcilable to its pre- 
sence ever after. 

724. The cure of either of these conditions of the stomach re- 
quires much perseverance and determination — it should always, 
however, be attempted. The best plan, we believe, (at least it 
proved so in our own case,) is, first to make the object endurable 
to the eye, by viewing it steadily and frequently for some time : 
if this be persevered in, with a determination to conquer, it will 
be found that the object will gradually lose its annoying force. 
Afterwards, the eye becomes familiarized to its presence, or can 
look upon it with indifference — this is a great point gained. 
The next step is to accustom the nose to bear its effluvium with- 
out repugnance, when it is near you at table: when this can be 
supported, the cure is near at hand; for the stomach is much 
influenced by the eye and the nose. The taste is next to be re- 
conciled — this is best done at a time when strongly urged by 
hunger. Small quantities may be given at a time: should the 
stomach not now revolt, it may be swallowed with impunity. 
This must be occasionally repeated, until the aversion is over- 
come. 



CHAPTER 2 



TO CHILDREN? 



725. This question is very often asked, and is almost as va- 
riously answered. This arises frequently from the fondness or 
dislike people may have for certain substances, rather than from 
absolute experience ; believing the substance of which they them- 
selves are fond to be always innocent, and that to which they 
have aversion, or which may have accidentally disagreed, to be 
always injurious. To those who are able to judge for themselves 
we shall offer no observations upon the various articles of diet 
constantly presented to them — they must be regulated by their 
own experience; for, if this will not render them judicious in 
their choice, they must submit to the penalties attached to vo- 
luntary error. 
13 



194: OF SUBSTANCES HURTFUL TO CHILDREN. 

726. Not so, however, is our determination with respect to 
children, for whose health we profess to be sincerely anxious, 
and are desirous to promote by every means in our power. We 
shall, therefore, offer a few observations upon various substances 
in common use, and of which children are almost constantly made 
partakers. 

727. There cannot be a more absurd question than, "Is such 
a thing wholesome?" since, to be answered safely, requires so 
many considerations, and so many exceptions, that no one should 
venture to answer it either affirmatively or negatively, before 
duly weighing them. Whenever the late Dr. Cullen was asked 
this question, he inquired of the speaker, " Does it agree with 
you?" If answered in the affirmative, he would declare it to be 
wholesome. This, for a person who has experienced the effects 
of an article, is a most judicious answer; but to the child who 
has no such experience, such answer cannot apply. With a view, 
therefore, to aid the choice, we shall consider the subject a little 
in detail, and endeavour to fix some general principles, founded 
upon the influence of various substances upon the tender and 
unconfirmed stomachs of children. We shall, therefore, lay 
down certain data, and reason from them as this may become 
necessary. 

728. 1. That nature never intended that children who have 
no teeth should be nourished by precisely the same aliment as 
those who have, and the reverse. Therefore, the food that may 
be proper for one might be decidedly injurious to the other; con- 
sequently, animal food, pastry, fruit, confectionary, &c, would 
be positively injurious to the child without teeth. Yet neither 
of these substances, under proper circumstances, and in proper 
quantities, should be considered as positively hurtful, since they 
are only so quo ad hoc. 

729. 2. The food which may be proper after dentition is com- 
pleted may be highly injurious while this process is going on ; 
hence, animal food, or any other stimulating article of diet, may 
be looked upon as positively injurious — though it be only for a 
limited period. 

730. 3. The food for adult age, if employed before puberty, 
would often be found highly injurious ; though the general ex- 
perience of the world would deny their being positively hurtful 
in themselves. 

731. 4. The food w T hich universal experience may declare to 
be " wholesome," can only be so when taken in proper quantities, 
at proper periods, and under proper circumstances ; therefore, 
any substance, in undue quantity, and at an improper season, 
may become hurtful ; but must not be declared positively injurious, 
in a general sense. Consequently, when we speak of food, on 
which thousands have lived and did well, or from which others 



OF FRESH FRUIT. 195 

have suffered, being either wholesome or unwholesome, we must 
mean it is either the one or the other, according to the age and 
constitution; to the particular circumstances under which the 
body may be placed, as climate, sickness or health ; or to the 
quantity, or particular quality, of the articles in question. 

732. It must not, however, be inferred from what has been 
said, that we consider every article of diet equally proper — far 
from this : for though we do not admit that any of the usual 
articles of food are positively hurtful in themselves, yet we de- 
clare, it will always be proper to make a choice from them ; and 
on that choice will very much depend the proper health of the 
individual who may employ them. Thus, we have already de- 
clared that the meat of one animal is better than that of another ; 
and so of many other substances. Yet, the best of either of these 
articles maybe highly pernicious when injudiciously administered; 
and the worst of them may be useful under certain conditions of 
the body. 

733. Having made these preliminary remarks, we shall now 
proceed to our proposed inquiry — Are there substances in common 
use as food, which generally disagree with, or are improper for, 
children, before the first dentition is completed? If there be, 
what are they ? This question is, perhaps, fully answered already 
in various parts of this work ; but, as indulgence in certain articles 
at the period designated may be too often granted, and thus tend 
to either the immediate or remote injury of the child, we shall 
consider them in detail ; and, first, 

Sect. I. — Of Fruit in General. 

734. Fruit may be considered, generally, of two kinds — 
namely, fresh, and dried. 

Of Fresh Fruit. 

735. The fresh may consist of apples, pears, peaches, cherries, 
raspberries, strawberries, melons, dewberries, blackberries, whor- 
tleberries, grapes, oranges, pine-apples, &c. 

736. Various opinions are entertained of the respective whole- 
some qualities of the articles above enumerated, when ripe; but 
we believe there is only one, namely, that they are highly in- 
jurious when they are not so. We shall, therefore, always be 
considered, when speaking of fruit, to mean ripe or mature fruit, 
unless it be expressly stated otherwise. 

737. We limit ourselves, when speaking of the effects of these 
articles, to the period before the first dentition, or the first two 
years of a child's life ; and it may be asked, — Is fruit of any kind 
proper for children of that age ? 



196 OF FRESH FRUIT. 

738. This question must mean one of two things — is fruit a 
proper article of diet for children, at the period spoken of; or, 
will the occasional indulgence of a small quantity be improper? 
As to the first, we would decidedly condemn any article enume- 
rated, since it is almost uniformly mischievous. When fruit is 
forbidden to children, it is asked, how can it be bad, since they 
are so fond of it, and since nature has furnished it so abundantly? 
As regards the first question, we would ask, are not children as 
fond of wine, ardent spirits, and many other improper things, as 
of fruit ? Yet you would not give them either of these because 
they might take a fancy to it. They would eat the fruit of the 
Jerusalem cherry, the berries of the laurel, or the seed of the 
stramonium, with, perhaps, equal avidity, though death would be 
the immediate consequence of the indulgence. And, as regards 
the second, nature has spread her poisons with as profuse a hand 
as she has her more salutary fruits ; consequently, the abundance 
of the substance cannot prove its usefulness as food. 

739. We, therefore, are of opinion, that whenever such a 
quantity of fruit is given to a child as shall, either by its quantity 
or quality, materially change the nature of the digested product, 
it is always bad; consequently, such a proportion should not be 
permitted to enter the stomach. Nor do we think it always safe, 
even in smaller quantities. If, on the other hand, so small a 
quantity be given as not to influence the digested product, it 
may be given without injury, but, we believe, never with advan- 
tage. 

740. Fruit, by most people, is not only considered innocent, 
but positively useful; therefore, a free indulgence is generally 
permitted in its use, without attending either to the age, peculi- 
arity, or condition of the person who may make use of it ; yet 
we hesitate not to say, that unless due regard be paid to each of 
these circumstances, fruit cannot be useful, and very often not 
even innocent. It is familiar to the experience of every body, 
that one class of substances is of more easy digestion than another 
— thus, animal food is of more easy conversion than vegetable. 
This, as a general rule, is strictly true; and of animal food, as 
we have already remarked, some is digested with much more ease 
than others. The same remark is applicable to the vegetable 
class — and of this class, fruit may be considered, with young 
stomachs, of more difficult solution than almost any of the fari- 
naceous substances in common use ; consequently, must be less 
proper. 

741. The insolubility of most fruits is well known to every 
body, either from their own experience, or from their observa- 
tions upon the confirmed adult stomach of others ; and with re- 
spect to children, the fact is notorious to all who may have charge 
of them. Who does not constantly witness these substances pass- 



OF FRESH FRUIT. 197 

ing rapidly through them unchanged, and especially at the age 
of which we are now speaking? Can it, then, be for a moment 
insisted on, that that substance which the stomach cannot master, 
is useful, or even innocent? Let us not then be deceived by 
mistaking the agreeable for the useful. 

742. At the age in question the indulgence in fruit of any 
kind should be very limited indeed ; and especially where the 
stomach and bowels are not in the most perfect health. After 
this period, it may be given in moderate quantities, without much 
risk ; but if there be even a small excess, the child is sure to suffer 
from a derangement of the stomach or bowels, or both ; or, if it 
escape from these evils, the stomach will be found less disposed 
for its ordinary meals, and the articles will be seen to pass un- 
changed. 

743. There is a vulgar error on this point which deserves 
correction ; as it has no inconsiderable influence upon the conduct 
of many, in administering fruit to children. The passing of 
fruit unchanged through the bowels has frequently been urged 
to us as a proof of its innocent nature; for, it is said, that "if 
the child have taken a little too much, or if the stomach cannot 
assimilate it, it always comes away." Now, this coming away 
unaltered is a direct proof that the stomach cannot digest it; 
and, of course, the child has been labouring under the effects of 
indigestion ; and though, in some instances, it has not produced 
any violent symptoms, it must, nevertheless, be admitted that 
the child runs a great risk. We should, therefore, lay it down 
as a positive rule, that whenever this is observed with regard to 
any substance, no matter what, the stomach itself is out of or- 
der, or that the particular substance is not suited to its powers, 
or condition, and must not again be urged upon it. It is owing 
to inattention to these first revolts of the stomach, that dyspep- 
sia is produced; and farther heedlessness too certainly confirms 
it. 

744. There is another vulgar error with respect to certain 
fruits, which is even more mischievous than the one just men- 
tioned ; namely, that they are not merely innocent, but posi- 
tively wholesome. This opinion is especially entertained of the 
dewberry and the blackberry; hence, they have but too often 
been administered to children who were labouring under acute 
or chronic diarrhoea, to the imminent danger of their lives. We 
have witnessed, this season, (August, 1825,) three instances of 
dangerous cholera, brought on by means of these fruits ; and one 
which had nearly proved fatal from the use of the syrup of the 
blackberry. These instances are far from being rare; we have 
observed more or less of them, ever since we have been engaged 
in practice. 

745. We are fully aware how difficult it is to eradicate a long 



198 OF FRESH FRUIT. 

established error ; and that the dictum of an old woman will 
very often outweigh the experience of the physician. We do 
not, therefore, calculate too largely upon the force or influence 
of our opinion upon this important point. We feel it, however, 
a duty to state that which has been sufficiently confirmed to us 
with respect to these fruits, when exhibited as a remedy — name- 
ly, that we have never known them to be useful, but we have 
very often known them to be injurious. 

746. Another vulgar error is deserving of notice — namely, 
that "when cherries are eaten, the stones should be swallowed, 
to promote digestion." This is one of the most absurd, as well 
as dangerous errors, that popular opinion continues to cherish ; 
it is one replete with mischief, and has neither reason nor ex- 
perience to countenance it. This mischievous practice, most 
probably, took its origin from the mechanical theory of diges- 
tion, or from some ill-selected analogy. It was formerly taught, 
that the human stomach subdued the substances presented to it 
for digestion by a mechanical action ; and that, consequently, 
cherry-stones performed the same duty in it as the gravel in the 
gizzards of fowls. This opinion has been long disproved by the 
most satisfactory experiments ; but the errors to which it led 
still unfortunately continue to prevail ; and this with a class of peo- 
ple from whom one would rationally expect better formed notions. 

747. The same disposition to theorize has found a utility for 
the purpose of digestion, in eating the skin of the apple and 
peach. They say, that nature intended the skin to promote this 
object; or why were they formed? The same reasoning would 
render it proper to swallow the shell of the walnut, and the rind 
of the pine-apple ; but did not the opinion lead to practical in- 
jury it would not have been worth the trouble to expose its ab- 
surdity. 

748. From what has been said the following principles, we 
think, may be established: — 

749. 1. That before the child has attained its second year, 
fruit in any quantity cannot be considered useful ; though very 
small quantities, properly administered, may do no injury. 

750. 2. That after the second year small quantities of fruit 
may be given with less risk ; especially if we duly attend to the 
circumstances which should always regulate its exhibition. 

751. 3. That it should never constitute the chief article of 
diet ; since, in such a proportion, it would so alter the digested 
product as might seriously injure the functions of the stomach. 

752. 4. That fruit, of almost every kind, is less digestible 
than any of the farinaceous substances in common use. 

753. 5. That when the stomach is incapable of assimilating 
it, much disturbance in the stomach and bowels is excited, ter- 
minating oftentimes in cholera; or> 



OF DRIED FRUITS. 199 

754. 6. If it do not produce this evil, it passes from the 
bowels in an unaltered state ; and when this is the case, it is a 
certain evidence that it is injurious. 

755. 7. That as a general rule, the older the child, the less 
the liability to injury from fruit, provided it be taken at proper 
times, and in moderate quantity. 

756. 8. That it is an error to suppose that any fruit is posi- 
tively useful as a nourishment, or as a medicine, to young chil- 
dren. 

757. 9. That it is also an error, and one of a serious kind, to 
swallow the stones or skin of fruit, with a view to promote di- 
gestion. 

Sect. II. — Of Dried Fruits, 

758. The dried fruits are raisins, cherries, apples, peaches, 
figs, prunes, &c. Of these it may be said with safety that they 
are still more exceptionable than the fresh, but not all in an 
equal degree. The most injurious are the first four named. 
Raisins are extremely indigestible, unless deprived of their skin ; 
and should never be eaten, without attending to this precaution 
— there is no stomach, unless it be that of the ostrich, of whose 
powers of digestion we hear so much, that can master the skin 
of a raisin — we know, from observation, that a hog cannot over- 
come this insoluble substance; yet they are given by indulgent 
parents, in large quantities, to children of every age, and of 
every power of stomach, to either their immediate or remote 
injury. We have known three instances of convulsions and death, 
from the excessive use of this fruit. 

759. Of the dried cherries, apples, and peaches, it may be 
said that they are altogether unfit to be received into the stomachs 
of children, and especially young children. 1 They are rendered 
fitter for the purposes of food, by having them well stewed ; but 
even then they should be taken in very moderate quantities — ■ 
particularly the cherries and dried apples. The fig, and the 
prune, are less exceptionable than the articles just named: but 
they cannot be freely indulged in, with entire safety, by young 
children. The adult stomach, when sound, bears them with 
advantage when taken in moderation, especially where the 
bowels are tardy — but they never should be given for the same 
purpose to young children. 

1 We saw an instance of long continued and severe convulsions in a child of 
four years old, from eating a quantity of dried apples, which he had procured by 
stealth ; his recovery was doubtful for a long time, and nothing but being relieved 
of the offending cause, by an active emetic, saved his life. 



200 OF EXERCISE. 



CHAPTER XL 

OF EXERCISE. 

Of such importance do we consider a well directed and pro- 
perly organized system of exercise, that we must hold every 
system of education imperfect that does not include it among 
its essentials. For, without this, we can declare, from extensive 
personal observation, much mischief is sure to follow : while, on 
the other hand, we can safely say, where it has been well sys- 
tematized, it has uniformly tended to the successful development 
of the body, as well as contributed largely to the invigoration of 
the mind. With these objects in view, we were mainly instrumen- 
tal in establishing the gymnasium, that is now dispensing so much 
benefit to youth and others, in our city ; and to the practices of 
which we cannot too pointedly recommend the attention of pa- 
rents and guardians, who may be solicitous about the welfare of 
youth under their care. 

760. Under the head of exercise, we shall include, 1st, the 
exercise or motion useful or proper for very young children, up 
to the period of their beginning to walk ; 2dly, walking ; 3dly, 
other modes of exercise — A, riding in a carriage ; B, riding on 
horseback; C, games of various kinds; D, dumb-bells, and the 
various exercises of the gymnasium. 

Sect. I. — Carrying in the Arms. 

761. Under this title we may comprehend almost the whole of 
the motion, or exercise, which can be usefully employed for 
very young children ; and this may commence with advantage 
a few days after birth. An error is very frequently committed 
by nurses and mothers, in confining the child constantly to the 
bed, or cradle, covered with clothes, or buried in feathers, in- 
stead of carrying it about the room several times a day, carefully 
placed upon a pillow, that it may enjoy a renewed atmosphere, 
and have an opportunity of exercising its little limbs, to which 
this important indulgence so strongly invites them, even before 
they are a fortnight old. The custom of confining a child at 
this early period of its life, arose from the absurd aphorism, that 
"the more a child sleeps, the faster it grows." 

762. It should be ever kept in view, that children, with respect 
to exercise, are precisely on a footing with adults, making the 
proper allowances for degree. The muscular system of the child, 
like that of the adult, can be strengthened only by exercising it; 
and the circulatory, nervous, and absorbent systems, can only 



OF EXERCISE. 201 

be kept healthy, by the due and proper play of the muscular ; 
therefore, for the purposes of health, it must acquire tone, by a 
•well regulated plan for this purpose, or all the systems just men- 
tioned will become deranged, or even diseased. 

763. If this be true, it will be readily admitted, that the 
sooner we commence with this important part of physical treat- 
ment, by a well adjusted plan, the sooner will the muscular sys- 
tem acquire the tone so important to the many other functions 
of the body. 

764. To begin, then, with this useful practice sufficiently early, 
the child should be taken several times every day, after its 
wakings, from its nest of feathers, (even at ten days old,) and 
placed upon a plain, and sufficiently soft surface; freed from all 
restraint, and left to the enjoyment of its own sensations. In 
obedience to these, it will soon be found to exert its feeble limbs 
in every direction; and manifest, by its repeated efforts, the 
delightfulness of its feelings. It will discover, after a few trials, 
how much it enjoys this freedom from restraint, and the advan- 
tage it is deriving from it, by an increased motion, and force 
of its limbs. In the position we recommend, namely, upon its 
back, it has a full opportunity of exercising all the larger mus- 
cles of the body; and it is surprising, when permitted, how 
rapidly the child acquires strength. 

765. All seem to be aware of the necessity of exercise to 
strengthen the muscles; but there are very few who institute a 
regular and proper series of experiments for this purpose. In- 
deed, the exertions the poor infant is obliged to make in the 
hands of its nurse, are calculated to do it more injury than good. 
The pride of the nurse, and too often that of the parent, becomes 
highly interested in the display the child is forced to make, in 
keeping itself erect; and when, from long and often repeated 
trials, the little creature is able to straighten its spine, it is 
praised for its forwardness, or quoted as a prodigy. But this 
kind of management is decidedly wrong; since all this apparent 
vigour is oftentimes procured at the expense of some permanent 
derangement of the spine. 

766. It will be evident to every reflecting mind, that the in- 
completely ossified spinal column is but ill calculated, at the 
period now supposed, to sustain the weight of the whole body, 
and the head beside, and, when forced to do so by this injudicious 
management, it must yield in a greater or less degree; hence, 
crooked spines. We would, therefore, peremptorily forbid all 
such displays. Yv r e are well acquainted with a nurse, who, from a 
perseverance worthy of a more noble and useful object, teaches 
the children she has charge of to sit perfectly upright, within 
the period of the month : it is truly ludicrous, as well as unna- 
tural, to see the little creatures sitting as straight as if they were 



202 OF EXERCISE. 

stiffened by a back-board. What may, ultimately, be the result 
of such a plan, remains to be proved — reasoning upon the subject 
leads to nothing but gloomy anticipations. 

767. From what has been said it will appear that however 
important exercising the muscles may be, it, nevertheless, must 
be done without obliging the spine to support the weight of the 
body; as it must do when the child is placed in an erect position. 
The employment of the muscles must be the result of the volun- 
tary act of the child; and it will most certainly and successfully 
exercise its volitions when placed in a position which frees it 
from restraint ; as on its back, with its head a very little elevated. 
When thus situated, with all its limbs at liberty, it will, in a very 
short time, become so familiar, and so pleased with its exertions, 
that it will every day more and more employ the muscles of 
these parts ; and, in a little time more, it will use those upon 
the posterior part of the body to the manifest advantage of the 
yet feeble spine. 1 

768. Another error is usually committed; namely the mis- 
management of the head of the child, during all the various 
attempts to make the child sit straight. During this discipline, 
the head of the poor little infant is permitted to hang on one 
side constantly, or it is suffered to roll about, as if it were but 
loosely attached to the body. The injuries arising from this 
inattention, are — 1st, the child acquires a habit of holding its 
head upon one side, which is difficult to overcome ; it also does 
mischief to the neck itself; for, 2dly, if permitted to roll about, 
injury may be done to that part of the spinal marrow which 
passes through the vertebrse of the neck, by the head making, 
from some cause or other, too large a sweep ; or, in other words, 
describing too large a portion of a circle. 

769. To prevent these evils, we would recommend, — first, that 
the child should never be placed in an erect position for any 
length of time, before the spine is sufficiently confirmed to sup- 
port the superincumbent weight, and the muscles have acquired 
strength to support the body in that position, without too much 
fatigue ; and, secondly, if the child must be placed in an erect 
position, for any necessary purpose, the head should always be 
steadily sustained by the hand of the nurse being placed under 
it. The cautions now suggested are particularly important in 

* The universal and preposterous practice of bracing children, as it is called, 
by straps, back-boards, corsets, &c, has ever given rise to the disease they were 
intended to prevent or to cure — namely, obliquities of the spine. This affection 
first shows itself by one shoulder becoming lower than the other, and by a pro- 
jection of the portions of the shoulder blades next to the spine. These bones are 
so elevated, sometimes, as to appear detached, or separated from their proper loca- 
tion. We would, therefore, advise a mother, when she observes this change in 
the child's shape, to apply immediately to an experienced physician, instead of 
attempting to cure it by the several contrivances just enumerated. 



OF EXERCISE. 203 

respect to feeble, or very heavy children, or those disposed to 
rickets or scrofula. 

770. The child's body may be placed so as to make an angle 
of a few degrees with the horizon ; but when this is done, it 
should always be by the hand of the nurse sustaining the back 
and head, by placing it against the shoulders and head. The 
child may be carried about in this position, and gently exercised, 
by a movement up and down : this may be repeated several times 
a day, for a minute at a time. But we must earnestly deprecate 
a too rapid motion, even in the direction prescribed ; but, espe- 
cially, a whirling motion. If the movement prescribed (770) be 
gently and properly managed, it not only tends to give strength 
and vigour to the child, but becomes a certain source of amuse- 
ment to it, as is clearly demonstrated by its joyful expressions, 
and strong attachment, after awhile, to those who perform it. 

771. We have said this motion should be gently performed : 
we would rather wish to be considered as insisting upon this as 
an essential condition; for if it be rudely done, mischief may 
follow from the sudden shock the nervous system may receive. 
The child, when this movement is carried to excess, expresses 
its dislike and apprehensions by the sudden starts of its body ; 
by its wild and affrighted looks ; and by its convulsive sighs and 
crying. We have strong reason to believe, in one instance, that 
death followed from this movement being too suddenly and vio- 
lently performed. When properly conducted, it has all the ad- 
vantages of swinging. The same censure must be passed upon 
running violently with the child in the arms, hastily descending 
the stairs, jumping, &c. 

772. After the child has acquired sufficient strength to sit up 
without much support, it may advantageously be indulged in it, 
if properly managed; that is, not too long at a time, nor too 
often repeated. The spine of the child will rarely acquire such 
firmness as to render this proper, before the third month — after 
this time, it will, all things being equal, gain strength daily ; 
and may now be occasionally carried on the arm of the nurse, 
provided she handle it properly — for on this much depends. We 
shall, therefore, lay down the following rules for carrying children 
on the arm: — 

773. 1. It should never be so placed upon the arm as either 
to oblige it to support itself, or fall backward. To prevent this, 
the hand of the arm on which the child does not rest should be 
so placed over its body and chest as to give a certain support 
to the whole body. 

774. 2. It should never be carried upon the arm, without ad- 
ditional support, until the muscles of the neck have acquired 
sufficient strength to carry the head straight, for reasons already 
suggested. 



204 OF EXERCISE. 

775. 3. It should not always be confined to one arm ; for if 
it be, it will, from maintaining one position too long, contract a 
habit of leaning to one side, or become crooked — therefore the 
arms should often be changed. 

776. 4. It should not be made to put an arm around the 
nurse's neck, while placed on the arm for carrying; as it will do 
injury to the side and back by forcing out the shoulder-blade. 

777. 5. Neither should it be too firmly grasped by the nurse's 
arm, lest it bend or distort the bones of the pelvis, thighs, and 
legs ; and on this account the child should not be often trusted 
to those who are unskilled in carrying one ; as they always em- 
brace the child very firmly, from an apprehension they may let 
it fall — an experienced nurse can carry a child without much 
pressure. This rule is of especial consequence to such children 
as may be disposed to rickets. 

Sect. II.— Of Walking. 

778. Before a child can learn this important art, if we may so 
term it, it has to acquire several powers — 1st, that of using its 
limbs in all directions; 2dly, crawling, odly, standing, or ba- 
lancing; 4thly, the moving without falling, of one leg before the 
other; which in its perfection is walking. 

779. We have already directed the best method of insuring 
the first, which, if properly pursued, will quickly lead to the 
second, in which the child should be most freely indulged, with- 
out regard to the soiling of clothes; or the destruction of such 
perishable articles as it may be able to lay its hands upon. Most 
parents have an aversion to this necessary acquirement, and too 
frequently endeavour to interrupt it, to the decided injury of their 
offspring. We have constantly observed, that those children who 
learn to crawl are always more robust, and better confirmed in 
their walk, (though they sometimes do not begin so early,) than 
those who have been taught to walk without this useful interme- 
diate step. The act of crawling exercises every muscle of the 
body, and this without much fatigue, since it is a voluntary act 
of the child; besides, it is highly pleased by the employment of 
this power, for it always has an object for its exertions, and, con- 
sequently, is sure to be amused. This exercise, therefore, not 
only gives vigour to the body, but also agreeably stimulates the 
mind. 

780. Children permitted to crawl will soon wish to do more; 
hence they will endeavour to lift themselves upon their feet by 
the aid of a chair; and though they may fail in many attempts, 
they seem to feel it to be a point proper to gain, and will per- 
severe until they accomplish it; by this they learn — 1st, to raise 
themselves from the floor; and, 2dly, to stand, by holding the 



OF EXERCISE. 205 

object on which they have seized. Presently, they can balance 
themselves without holding, and will proudly show you they can 
stand alone. But fearful of yet trusting themselves to move 
their limbs, without support, they do not venture to put one foot 
before the other ; but by seizing a chair, or some other support, 
they will venture to advance as far as the limits of their support 
will permit. This little adventure is repeated again and again, 
with increased exultation ; when, after numerous trials, they feel 
confident of their powers to balance themselves, and, to the in- 
expressible joy of the parents, they run alone. When children 
learn to walk by this important gradation, it is always found 
that no injury is done to the proper form of the legs, which but 
too frequently happens by the other plan. 

T81. It may, therefore, be useful to caution parents and nurses 
against the unnatural practice of forcing very young children to 
"find their feet ;" since curved legs are almost sure to result 
from the practice. 1 Children disposed to rickets should be par- 
ticularly preserved from this mischievous exercise. For it, doubt- 
less, was the intention of the Creator, that children should not 
walk before a given period; therefore, to prevent an abuse of 
this law, he annexed a penalty to its infringement. 

782. We grant that children may be taught to walk without 
previously crawling ; but, at the same time, we must insist that 
there is no advantage in this plan — nay, there is often positive 
injury, the limbs are almost sure to be curved, and the walk of 
the child is marked by an uncertainty which does not obtain by 
the other plan. By crawling, the bones of the legs and arms 
strengthen with the muscles, and this without curvatures of the 
legs, since they are not forced to support a weight beyond the 
power of resistance. 

783. Many plans have been devised to teach children to walk 
— we without ceremony condemn the whole, since they all con- 
sist in obliging the child to make exertions injurious to the form 
of their limbs — of this kind are the go-carts, the leading-strings, 
&c. The go-cart and leading-strings are banished from the nur- 
sery, in almost every part of this country ; and we sincerely 
hope that no false theory, or an attempt at a "royal road" to 
walking, may ever cause them again to be introduced. Those 
countries in which these artificial means have been most fairly 
tried, abound in most ill-formed legs — an indisputable evidence 
of their mischievous tendency. 

x Does not nature point out the fact that very early walking is not one of her in- 
tentions, by developing the lower extremities, while in utero, more slowly than 
the upper ? which disparity continues, for even months after birth. It would seem 
to say, there is no necessity for a more ample development of the legs, as their 
use will not be required for some time. Whereas the use of the arms is imme- 
diately required after birth for the purpose of aiding itself in the acquirement of 
its food. 



206 OF EXERCISE. 

784. Teaching children to walk by taking hold of one of their 
hands, is also a very exceptionable mode. In this case the arm 
is severely extended; and, should the child make a false step, it 
runs the risk of a dislocation, by the violent and sudden attempt 
to save it— or, should it escape a dislocation, the arm suffers a 
violent extension of its muscles and ligaments, from which it is 
sometimes a long time before it recovers, as well as subjecting 
the poor child to a great deal of pain. Both hands being held 
at the same time, is less exceptionable, but not entirely free from 
objections. The best way is to let the child depend pretty much 
upon itself — taking care to break a fall, by gently seizing it round 
the waist. 

Sect. III. — Of other modes of Exercise. 

785. After a child has learned to walk with tolerable steadi* 
ness, it is eager to employ its locomotive powers, by moving al- 
most constantly from place to place, either to relieve ennui, or 
gratify curiosity, or both; hence the desire of motion being so 
universal, that it may be considered an instinct. This kind of 
gratification they should be liberally indulged in, since it keeps 
the mind amused, and profitably employs the muscular system 
—consequently, there can be no exercise so unexceptionable as 
that of walking under proper circumstances. But it may hap- 
pen, that, from the state of the weather, indisposition, or the 
distance to which it is desirable to remove them, other modes of 
transportation must be resorted to ; and the choice of such as 
present themselves, must depend upon the age of the child, dis- 
tance, &c. We shall, therefore, consider-— 

A. — Riding in a Carriage. 

786. Our remarks upon carrying children on the arm lead to 
the conclusion that it is not always the best mode of exercising 
them ; therefore we are of opinion that much advantage is often- 
times gained by the well regulated use of the " baby-carriage." 
This, however, to be as useful as it is capable of being, must be 
governed by the following considerations : — 1st, the vehicle itself; 
2dly, the mode of using it; and 3dly, the child. 

787. 1. The Carriage.— -It should be so constructed as to 
render it difficult to be overset; therefore the wheels must be 
made low, and revolve easily and equally; the axle should be 
wide, that the carriage may have even an over proportion of 
base. The body should be sufficiently long to permit the child 
to lie at full length, when necessary ; and of such breadth as shall 
prevent its being cramped when placed in it. It should be of 
such depth as will prevent the child from falling out; and its 
height should be so arranged that the child may be protected 



OF EXERCISE. 207 

from the sun when this may be necessary. The wheels should 
be secured against running off, when the carriage is in motion. 
The body should be placed upon low springs of sufficient elasticity 
and strength. 

788. 2. The Mode of using the Carriage. This is highly im- 
portant, since an error in this point may defeat its best uses. To 
be useful, therefore, it should always be drawn steadily, and at a 
very moderate pace; it should never be violently jerked, nor 
rapidly put in motion. The place for its employment should 
always be smooth and free from obstructions ; as its passing over 
rough places endangers the child, since it may overset, or do 
injury by the severity of its motions. 

789. 3. As regards the Child — That this kind of exercise may 
prove beneficial, the child must be so disposed in the vehicle as 
to be perfectly at ease. The most suitable position for this pur- 
pose will depend very much upon the age of the child; we may, 
therefore, divide this into three periods — the first period is that 
before the child can securely sit alone ; the second is where it is 
able to sit alone, but cannot walk ; the third is after the child 
can run alone. 

790. The position for the child in the carriage, at the first 
period, should be a horizontal one, and, for the reasons suggested, 
with its head elevated. It should be secured against receiving 
injury from a sudden jolt, by laying it upon a pillow, or an 
elastic mattress ; and so confined at its sides as to prevent its 
rolling when in motion. The one for the second period may be 
that of sitting; but the child must be so secured as to prevent 
too much motion of its body when the carriage is moving. For 
the third period the same position will be proper ; but there will 
be less necessity for the confinement just spoken of, as the child 
can now balance and support itself. Yet it may be proper to 
observe that the greatest care should be taken at every period 
to guard against the child's falling out. 

791. Children, when placed in the carriage, should never be 
kept standing in the sun, if it be warm; nor should they be kept 
motionless when the weather is very cold. Indeed, it would al- 
ways be best not to expose to either extreme, since the risk of 
injury is oftentimes greater than the benefit. When in the car- 
riage, in cold weather, they should be amply covered, since, from 
the passiveness of their situation, they will require addition?.! 
clothing. Nor should the ride ever exceed half an hour at a 
time, especially if the child be observed to become sleepy — and 
this for two reasons ; first, because it is always injurious to chil- 
dren to sleep in the open air; and, secondly, because, after a 
few trials, they will much prefer this mode of going to sleep ; and 
thus destroy a well established habit, to the serious inconvenience 
of the parent or nurse. 



208 OF EXERCISE. 

B. — Riding on Horseback. 

792. Perhaps there is no mode of exercise, equally beneficial 
with this, if we except walking — it is one which employs all the 
energies of the rider, and that in the most agreeable way. There 
is scarcely a muscle unemployed, and, at the same time, the mind 
is highly amused. We must, however, be understood to speak 
of those who feel a confidence in their horsemanship; for such 
only derive benefit from it. Therefore, a child, either male or 
female, should be early instructed in this important art. We 
say they should begin at an early period to take lessons when 
practicable; since, by doing so, they become more confident, 
and better confirmed in their seat. When placed on horseback 
at an early age, they quickly acquire intrepidity; first, because 
they have a natural attachment to a horse, which they suppose 
will not do them harm ; and secondly, because they cannot well 
anticipate all the risk they might run, either from the misma- 
nagement of the reins, or the viciousness of the animal itself. 
On this account, children are fearless on horseback, almost as 
soon as they are placed there ; and their enjoyment keeps pace 
with their trials ; and for these reasons the sooner they begin 
the better for every purpose of health or future usefulness. 

T93. We would advise, under circumstances which can com- 
mand this indulgence, that children commence, soon after their 
sixth year, to receive instructions under a careful and experienced 
master; and, as soon as they have acquired "a good seat," they 
may accompany their father, a friend, or a careful servant, for 
farther improvement and exercise. A timid child should not be 
forced suddenly to mount a horse, for any purpose : he ought to 
be placed under the immediate care of a judicious person, who, 
by address and management, will remove his apprehensions, and 
cause him eventually to acquire a confidence in himself. On 
this account a riding school is deserving of patronage. 

C. — Of Games and ^Exercises of various kinds. 

794. In large cities there is a great variety of games and 
exercises presented for the amusement of children; some of 
which are very useful, and others extremely injurious. It would 
occupy too much room to particularize the varieties, and reason 
upon them in detail. We shall, therefore, merely point out the 
tendencies of them all, and allow parents to choose such as will 
best conform to the general scheme of physical education. 

795. All the active games and exercises, (and these are the 
kinds we are now considering, since they afford that important 
aid to health, exercise,) employ all the muscles of the body with 
more or less severity; the remote tendencies of which are to 
confirm the strength and improve the skill of such as sufficiently 



OF EXERCISE. 209 

employ them. But these advantages are not always gained 
■without risk; either from the nature of the game or exercise it- 
self, or from the severity with which it may be pursued; there- 
fore, such as really may be attended with danger had better be 
avoided at once ; and only such followed as are not necessarily 
accompanied by risk. Of the former kind may be considered 
skating ; going into the water unprotected, before they can 
swim; descending from the tops of houses by a running rope, or 
windlass; diving or jumping into the water from a great height. 
&c. Of the latter, we may reckon playing at marbles, beating 
a hoop, flying of kites, playing at ball, or fives, shinny, &c. 
These last are not necessarily dangerous, but may be so acci- 
dentally — we would, therefore, lay down the following general 
rules upon games and exercises : — 

796. 1. Not to permit a child to engage in such as are in 
themselves dangerous, as those above enumerated; and not to 
allow the plea, that A., B., and C, daily engage in them with- 
out accident, to outweigh the force of positive examples to the 
contrary. 

797. 2. To allow a child to engage only in such as are not 
necessarily injurious; and even such within the bounds of mo- 
deration, in order that evil may not follow the indulgence — that 
is, not to overheat the body, nor check perspiration too sud- 
denly. 

798. To choose such of the latter as may prove least injurious 
to the child's morals ; for, by associating with vulgar characters, 
in the performance of certain games and exercises, much risk is 
incurred. On this account, a child is seldom safe, either morally 
or physically, who is permitted to choose its companions, the 
nature of its game or amusement, from under the parent's in- 
spection and control. 

799. Girls, from necessity, can have fewer games or amuse- 
ments than boys ; but there is a sufficient choice of these, for all 
the purposes of health, if properly pursued — such are, shuttle- 
cock and battledoor: skipping the rope, dancing, &c. Where 
circumstances will permit, a well arranged swing is one of the 
best, as well as one of the most delightful, modes of exercise, to 
those who can enjoy it. Riding on horseback, we are sorry to 
observe, is too little practised among our young females. Un- 
fortunately, this, like many other points essential to health, re- 
quires the powerful influence of " fashion," to bring it into use. 
There is, perhaps, no city in the world, where females enjoy this 
most salutary exercise so little as in this ; and, perhaps, there is 
none that offers stronger inducements to employ it. There are 
always masters to teach the art, where encouragement is given : 
but of the number who have offered their services to the public, 

14 



210 OF BATHING, AND CLEANLINESS. 

not one, we believe, has succeeded. On what does this supine- 
ness rest? 

D. — Dumb-Bells, 

800. The " dumb-bells" have been strongly recommended as 
an exercise for young people, especially when the weather will 
not permit it to be taken out of doors. These machines maybe 
profitably employed, we have no doubt, where the weight of 
them, and the manner of using them, are properly regulated. 
The general idea is, that they should be made as heavy as the 
strength of the person can wield, than which there can be no 
greater error — for all the advantage of weight can be gained by 
using light ones, if the motions of the arms be quickened, and 
this need not be done, but as the person acquires strength. But 
such as have the opportunity of attending the exercises of the 
" Gymnasium," will have the use of these instruments, as well 
os many other modes of exercise, properly pointed out, and their 
employment judiciously regulated. 



CHAPTER XII. 



OF BATHING AND CLEANLINESS. 



801. It is a popular belief, and one founded upon correct ob- 
servation, that the proper and healthy condition of the perspira- 
tory organ, — namely, the skin, — is highly important to health. 
Whenever this apparatus becomes deranged, either directly or 
indirectly, it is always found that the body is less in the enjoy- 
ment of health and comfort, than when this is in the full exer- 
cise of its functions. It will, therefore, follow, that whatever 
tends to maintain the sensible and insensible perspirations in 
their proper proportions, will essentially serve the purposes of 
health. It has ever been acknowledged that cleanliness is highly 
conducive to this desirable end; for, wherever this is neglected, 
disease is sure to follow — therefore, the impure state of the skin 
will sooner or later have its penalties. 

802. The ancients were well acquainted with this fact; and 
so attentive were they to the removal of all casual impurities 
from the skin ; so entirely convinced of the advantages resulting 
from it, that baths were erected and maintained, in many of their 
cities, at public expense ; of which the inhabitants of the respec- 
tive cities had a right to take advantage at any time they pleased. 
These valuable gifts of public munificence cannot well be too 
much praised or admired, and could they have been perpetuated 



OF BATHING AND CLEANLINESS. 211 

to the present moment, in all such climates where heat makes 
them desirable, incalculable advantages would have arisen to re- 
ward the liberal spirit by which they were maintained. 

803. Although there are no baths maintained at the public 
expense, in this country, we are, nevertheless, in possession of 
sufficient facilities for bathing in almost every part of the United 
States, either by means of running water, or the late general 
introduction of baths in almost every well built modern house 
in our cities. Therefore, when this important auxiliary to 
health is not attended to, it must be attributed to reprehensible 
neglect. 

804. Parents who are inattentive to the important duty of 
having their children well cleansed, by the frequent application 
of water to their skins, disregard one of the most valuable pre- 
cepts which Hygeia can give, or that they can obey ; and for the 
neglect of which no adequate excuse can be urged, especially as 
the means are at the command of every body. In a climate like 
the one we are subject to, where the extremes of heat and cold 
are alternately experienced in their respective seasons, too much 
care cannot be taken to preserve the skin in its most healthy 
condition, especially during the summer months, that disease 
may not result. Therefore, the useful discipline of washing, 
(every young member, at least, of the family,) should never be 
omitted. If this were done daily, during the warmer parts of 
our seasons, it would be but complying with a necessity constantly 
created by the action of heat upon the skin ; it should not be 
omitted beyond every other day, unless some circumstance of 
health might render it improper. 

805. The object of all bathing is to remove impurities arising 
from dust, perspiration, &c, from the surface, that the skin may 
not be obstructed in the performance of its proper offices. But 
it requires to be cautiously conducted, that the subject may not 
be exposed to the risk of taking cold — it should, also, be so 
managed that too much reaction shall not be excited. To insure 
these important ends, the bath should be of tepid warmth, at least 
for several of the first years of the child's life ; for by having 
the water very moderately warm, we remove with more facility 
and certainty the impurities from the skin ; we prevent taking 
cold, and do not excite too much reaction. Of the best mode 
of conducting the bathing we shall speak by and by. (827, &c.) 

806. We are aware we are advancing opinions not in con- 
formity with public prejudice ; but we declare them without hesi- 
tation, as we are certain they are sanctioned by both reason and 
experience. The" cold is the favourite bath of people in general ; 
but why it should be so, we are utterly at a loss to understand. 
This popular feeling originated in some unaccountable prejudice, 
or from an imposing but limited experience. But as it has taken 



212 OP BATHING AND CLEANLINESS. 

possession of the public mind, it may be well to urge with all due 
candour our objections to its employment. 

807. 1. There are many latent predispositions to disease, or 
disease in an obscure form, to which the cold bath would be highly 
injurious, by calling into action the dormant affection, or by ex- 
alting the one already present. 2. There are many constitutions, 
wherein the powers of reaction are so feeble that the body is left 
in a state of exhaustion for a long time, because reaction is tardy 
in taking place ; and wherever this happens, the system is sure 
to be weakened, instead of being invigorated. 3. There are 
many who have strong dispositions to local determinations of 
blood, as to the head, lungs, liver, &c; in which cases the cold 
bath is decidedly mischievous, by encouraging or producing 
these determinations. 4. It has, sometimes, the most injurious 
effect upon the nervous system, producing a kind of syncope, or 
catalepsy. We know a lady who was nearly destroyed in this 
way, by a single plunge in the cold bath, although of moderate 
temperature — the warm or tepid bath she much enjoys. 5. The 
reaction, after cold bathing, is sometimes excessive, amounting, 
in some instances, to temporary fever ; and when this subsides, 
the muscular system is found weakened. 6. It never answers the 
purposes of cleanliness so well as the tepid or warm bath — there- 
fore, one of the principal advantages for which it was resorted 
to is defeated. 7. It is always commenced with strong repug- 
nance on the part of the subject of it, whether it be a very young 
child, or a child of more advanced age — the first manifests its 
aversion by crying during the continuance of the discipline ; the 
second by strong opposition, crying, &c. 8. In very young chil- 
dren, it sometimes produces severe pain in the bowels, which can 
only be allayed by laudanum, as the following case, among others, 
will show : — 

808. We were requested to prescribe for a child of six weeks 
old, who, from the moment it was stripped for dressing, began to 
cry, and would not cease, until it took laudanum, for the purpose 
of quieting it; and this was uniformly the case, from the first 
dressing after its birth. We inquired into the mode of washing 
and dressing it, and were informed that the nurse had begun by 
washing it with cold water, and the practice had been continued 
ever since ; and that as soon as the water was applied to it, it 
would begin to scream; that after it had been well washed from 
head to foot with the water, it was again washed with cold whis- 
ky, and then dried and dressed ; that it remained cold and shiver- 
ing for a long time after the washing ; and that it continued 
unceasingly to cry, until quieted by laudanum or carminative. 
We recommended that it should be washed with warm water in- 
stead of cold, and to lay aside the use of the whisky. On the 
repetition of our visit, a few days after, we were informed that 



OF BATHING AND CLEANLINESS. 213 

the child had been nearly quiet during the dressings, and only 
cried while that was carrying on, and ceased altogether to do so, 
as soon as this duty was performed ; and that it had not required 
laudanum since the warm water had been substituted for the 
cold. 

809. In the case just related, it is evident that the use of the 
cold water was injurious; it produced a painful condition of the 
bowels, which could only be relieved by anodyne medicines. 
The child, therefore, was not only made to suffer much pain by 
its use, but was acquiring a habit of taking laudanum, which 
could not fail to be ultimately injurious. 

810. It must, however, be understood, that we are not con- 
demning the cold bath, without reserve ; on the contrary we re- 
gard it as a highly important remedy, where the condition of the 
system indicates it; but we are decidedly of opinion that the 
constant use of it should be reserved almost exclusively for this 
purpose. The occasional use of the cold bath to people in health, 
may safely be indulged in ; but it should be sparingly had re- 
course to, unless employed as a remedy. We shall not here 
treat of the cold bath as a remedy — our present object is limit- 
ed to the question, whether it, or the tepid bath, as a constant, 
daily, application, be most conducive to the objects of health 
and cleanliness. 

811. We are, however, by no means sanguine that we shall 
make many converts to the opinions we are advocating, as the 
prejudice in favour of the cold bath is inveterately fixed in 
the minds of most people. It is almost universally said to be 
" bracing," and the warm or tepid bath to be relaxing; than which 
nothing can be more unfounded : the cold bath, in many instances, 
such as those already enumerated, as well as some others, ceases 
to be bracing; while the warm, in those very instances, would 
decidedly have this effect. 

812. But there is scarcely any thing more vague than the re- 
lative terms of hot and cold, applied to the sensation created on 
the living body, by media of various temperatures. It will be 
proper, therefore, to signify, by some definite sign, what is to be 
understood by the cold and warm baths. 

813. By the cold bath we are to understand, water so reduced 
in temperature that, when applied to the human body, it shall pro- 
duce that sensation of coldness called a shock. Now, there are 
various conditions of the body which will necessarily prevent any 
fixed degree from producing this effect, unless we run into an 
extreme ; we can, therefore, only assume some general positions ; 
but we must always be understood to mean the effect of such ap- 
plication upon the body when in health. It will be readily seen 
that we can fix with certainty the lower extreme of temperature, 
since water will not bear a greater reduction than 32° of Fah- 



214 OF BATHING AND CLEANLINESS. 

renheit without freezing. The other is not so easily fixed, since 
it may vary from 62° to 82°, as we aire informed that the Bux- 
ton water is at that temperature, and a slight shock is experienced 
upon immersion; the medium would, therefore, be 72°. Water, 
at this temperature, will feel cold to the body ; and at 62°, it 
will be found pretty severe, especially in summer, if applied in 
the form of the shower-bath, though it is called temperate heat. 

814. The warm or tepid bath may consist, then, of a tem- 
perature, under some circumstances, above 82°, or from this to 
98°, the usual heat of the human body — beyond this, it becomes 
a "hot bath," and should, like the cold bath, be employed but 
as a prescription of the physician ; but we are not now consider- 
ing this important auxiliary, except as a means to insure clean- 
liness. Of this important part of physical education, too much 
cannot be said in commendation — it may truly be said to be a 
virtue. 

815. No mother should confide this duty to a servant — she 
should herself daily inspect the skin of her children, and see that 
no part of it has been neglected. It is not sufficient for the pur- 
poses of health or cleanliness, that the hands and face are washed 
— there are many other parts of the child's body which require 
a more rigid attention, and which, because out of sight, are too 
often neglected. Nothing, perhaps, in after life, so effectually 
administers to comfort as the practice of habitual cleanliness; it 
is also one of the most efficient means of preserving health. 
But this habit, (or we had like to have said, this virtuous feel- 
ing,) is rarely generated, if it have been neglected in early life. 

816. An attention to cleanliness costs neither time nor money 
beyond its worth ; for the cleanly man or woman can make their 
toilet with as much despatch as the sloven or the slattern ; and 
they gain by it that which the others can never experience — a 
feeling of inexpressible comfort. 

817. As a preventive of disease it stands foremost; for the 
origin of some of the most loathsome diseases may be traced to 
a neglect of this virtue; it should, therefore, be practised, and 
inculcated, from the earliest infancy to that period of life at 
which the child is able to judge for itself; when, if it have been 
brought up with proper habits, it will spontaneously decide in 
favour of bathing. Let any one inspect the nurseries of children 
who are slovenly, and of those carefully brought up, and the 
very first glance will convince him of the advantage of the latter, 
and the mischievous tendency of the other. 

818. Children may be so trained to cleanliness that, at a very 
early period of their lives, they will avoid soiling themselves. A 
friend informed us that the little patient of eight months old, for 
which we were prescribing, had not worn a diaper since it was 
a month old; nor had it in a single instance soiled itself, either 



OF BATHING AND CLEANLINESS. 215 

during the day or the night. When it felt a necessity, it would 
by signs make it known in such good time as to prevent accident. 
This we admit to be a rare instance of discipline, but it is not 
the less worthy of imitation. 

819. If this practice cannot always be attained, one of nearly 
as much consequence certainly can — namely, teaching the child, 
by frequently changing it, to feel uncomfortable when wet or 
soiled; and it will by its cries almost immediately make its con- 
dition known, and plead for relief. The above case shoVs us 
how successfully this has been done; and we believe we may 
safely add, how easily it may be done, if properly commenced, 
and duly persevered in. For such is the effect of custom and 
good management, that children will very early declare their 
wants as regards their evacuations, if they be frequently placed 
upon the chairs whenever they seem to manifest a desire to re- 
lieve themselves. 

820. The example of other children, when there are such, will 
much contribute to establish this habit ; if the older be placed 
upon the chair, the younger will soon be able to follow their ex- 
ample — and thus regularity will certainly be produced. This 
practice may be subjected to certain periods, by placing the 
child upon the chair at certain hours; for instance, soon after 
they rise in the morning, towards noon, and in the evening. 
But in doing this, the child must not be neglected at the inter- 
mediate periods, if it discover any marks indicative of its wants. 

821. Nothing, perhaps, will so decidedly prevent that dis- 
gusting and indomitable habit of "wetting the bed; " since no- 
thing so certainly tends to produce it as permitting children to 
remain long wet; as evacuation will follow evacuation, until the 
habit is confirmed,. by all sense of inconvenience being lost. 

822. It may be proper to say, en passant, that we do not 
confine the observance of cleanliness to the healthy condition 
of the body alone; for if the child be ill, frequent changes be- 
come even more necessary, though the popular opinion be 
against it. 

823. We have already declared ourselves to be in favour of 
tepid water for washing children, from birth until they are at 
least two years old. If at this period a change be thought de- 
sirable, the water may be used a little colder ; but it must be 
recollected that if a change be made, it should be done gradually, 
as we have just stated ; so that the constitution may not be sub- 
jected to too sudden a trial, by a great difference in temperature. 
Extremes of every kind, we again repeat, are dangerous ; there- 
fore, the gradation should be from tepid to cool, and from cool 
to cold, if this last should ever become necessary, even as a 
remedy. 

824. We would, however, caution the over-timid mother not 



216 OF BATHING AND CLEANLINESS. 

to mistake hot for warm, and thus defeat every advantage which 
the rules we are inculcating are intended to confer. This error 
would be as bad as the other, for injury would certainly follow. 
So much does theory sway the actions of every one, that man- 
kind frequently pursue opposite plans to accomplish the same 
ends. A delicate, frail constitution will be treated by contrary 
means, agreeably to the particular notions entertained by the 
person who has charge of the patient, respecting the cause of 
disease, or the effects of remedies. Thus, for the removal of 
debility* which they suppose to be the sole cause of disease, the 
cold bath is prescribed by some, with a view, as they say, to 
brace the system; while others will employ the hot, that the 
feeble strength of the patient may be fostered. 

825. In this case, either of the plans might be wrong, since 
each is an extreme; consequently, neither can be ultimately 
proper, except in a very few instances, and in no instance should 
we commence with either extreme. In all cases, the temperature 
of the water should be regulated by the degree of vital energy ; 
for, though children of enfeebled constitutions are invigorated 
by a moderate bath where there is no contraindication to its use, 
yet they would be as certainly injured by the sudden application 
of the cold bath. So, on the other hand, a similar state of body 
may be cherished and improved by the tepid, yet might be severely 
injured by the hot bath. 

826. But as neither the hot nor the cold bath should be used 
without the advice of a physician, they should always be con- 
sidered as remedies of great power, and only to be used as such, 
and for the diseases for which they are proper. The indiscrimi- 
nate use of both has done more injury, we fear, than can be 
compensated for by the good derived from their proper applica- 
tion. 

827. Dr. Struve lays down the following rules for bathing 
young children : — "During the first three months of its life an 
infant ought to be bathed in moderately warm water ; l the next 

1 " The term moderately warm implies that degree of heat, when the hand, or 
if this be not sufficiently sensible, the foot, may remain in it for some time, with- 
out experiencing the least disagreeable sensation. The lukewarm bath is about 
the temperature of warm milk. The cool bath signifies a temperature equal to 
that of water which has been kept in a room for a considerable time, so that its 
chilliness is taken off. And the cold bath ought to correspond with river water, 
in the height of summer," (p. 353.) 

It will readily be perceived that Dr. Struve's definitions of temperatures are 
extremely vague, since he does not measure them by the thermometer. Willich, 
his translator, has succeeded in being explicit, by saying, "Immediately after the 
birth of a child, the water in which it is bathed ought never to exceed the 98th 
degree of Fahrenheit's thermometer. By progressively reducing the warmth one 
degree every month, it will stand at 86° when the child is a year old, which, I 
presume, will produce the sensation of what Dr. Struve calls lukewarm:- — if this 
temperature be still farther reduced in the next twelve months, so that the mer- 
cury in the glass falls to 74°, when the child has completed the second year of its 
lifej it may then with propriety be termed a i( coqI bath" (p. 354.) 



OF BATHIXG AND CLEANLINESS. 217 

nine months, the water should be only lukewarm; after the first 
year, its temperature may be still more reduced; and after the 
second, the bath should be cool. From the third year of its age, 
we may venture to bathe a child in cold water ; but it should 
always be remembered, I do not mean as cold as ice." 1 

828. There can be nothing more preposterous, or injurious, 
than the empirical use of the hot or cold bath, since they are 
confessedly powerful agents; but warm, tepid, or cool water, for 
the purposes of cleanliness, may be daily used, under proper re- 
strictions, not only with safety but advantage. 

829. We say under proper restrictions ; by this we mean — 1st, 
that the child, when about to be washed, should be exposed no 
longer than is absolutely necessary for the operation ; 2dly, 
when the cleansing is done, it should immediately be well dried, 
and its clothes restored as quickly as possible; 3dly, in cold 
weather the water should be rather warmer than in hot weather; 
4thly, a little fine soap should always be used, hj previously dis- 
solving a small portion in the water, before it is employed, espe- 
cially for the lower half of the body ; 5thly, the head, particularly 
if the child be very young, should be first washed, dried, and its 
cap put on, before the other portions of the body are wetted ; 
6thly, children should never be dressed in a current of air ; Tthly, 
they should never be roused from their sleep for this purpose, 
nor washed immediately after walking ; but they may safely be 
permitted to sleep after the fatigue of dressing. 

830. When the conveniences present themselves, children of 
both sexes should be permitted, under proper regulations of de- 
cency, to bathe in running streams, ponds of pure water, or 
rivers, during the warm weather of summer. But this should 
always be done under the superintendence of adults qualified to 
protect them against accident. They may thus be instructed in 
that most useful exercise and art, swimming, of which no boy, 
(and why may we not add, girl?) should be ignorant after their 
ninth year. It is an important part of education that youth be 
taught to swim; and we regret that hitherto no proper establish- 
ment of this kind has arisen among us. The one purporting to 
be for this purpose has too many serious objections against it, 
to receive general patronage. In the first place, it is not con- 
ducted with sufficient decency; secondly, it is badly situated for 
the purpose; and, thirdly, it is much too expensive. 

831. We have employed the words bathing and washing 
synonymously in our present chapter. We think it necessary 
to explain this ; as in no instance have we wished to be under- 
stood submersion, by the term bathing, and when we have spoken 
of washing, it always had reference to the whole body undergo- 
ing this discipline, in distinction to the partial cleansing of the 
hands and face. 

■ Treatise, p. 353. 



218 OF DRESS. 



CHAPTER XIII. 

OE DRESS. 

832. We have already spoken of dress, when applied to chil- 
dren of the first period — that is, from birth to weaning. We 
shall now say a few words upon this important point from that 
time to the age of puberty. 

833. The object of all dress should be, first, to cover the body 
in such a manner that decency shall not be violated; and, 
secondly, to protect the body against the vicissitudes of the 
seasons. 

834. The first object may be easily attained; and this by the 
most simple means — to accomplish which it is only necessary to 
cover the body with a loose garment, of sufficient length and 
width. But this simple plan is rarely adopted ; as caprice and 
fashion, pride and ostentation, are constantly interfering with 
it; — hence, the immense variety of dress observed in the dif- 
ferent portions of the globe, as well as in contiguous places. 
Where a departure from the simplicity just spoken of does not 
injure by imposing restraint upon either the limbs or body, it is 
not a legitimate object for animadversion; since causes beyond 
our control will constantly be operating, to produce great variety 
in the form of dress. 

835. The mischievous and preposterous custom of swaddling 
is nearly abolished, in almost every part of the world; the child, 
from its birth, being now permitted more freedom for its limbs, 
which it exercises, accordingly, with much advantage to itself. 
But in fulfilling the second object, namely, a protection against 
the weather, many errors are committed — first, in the form of 
the garments, and secondly, in the quantity and quality of them. 

Sect. I. — The Form of the Garments. 

836. To a certain period, say until the fourth or fifth year, it 
is usual to habit both the male and female child pretty much 
after the same manner ; and, luckily, when this plan was adopted, 
the dress of the male was made to conform to that of the female 
— we say luckily, for so truly it was ; since the dress of the latter, 
in modern days, is much better calculated for both health and 
comfort, than that of the former. The loose style of dress now 
adopted for children, if persevered in, will certainly be of much 
consequence to the rising generation, since it imposes no restraint 
either upon the extremities or the abdomen. The stiff stays for 
female, and the tight waistbands of breeches for male children, 



OF DRESS. 219 

formerly in use have now yielded to the unconfined frock and 
petticoats in the one, and the modern invention of trowsers and 
suspenders in the other. By these changes a greater security 
is afforded for the preservation of health, since neither the chest 
nor abdomen in girls, nor the abdomen and lower extremities in 
boys, suffer from compression. 

837. We have already adverted to the evils which may arise 
from too great a pressure upon the abdomen, when speaking of 
the belly-band of infants; and it may now be proper to observe 
that our observations upon this point are not confined to that 
period of life — they extend, properly speaking, to every period; 
and will apply with much force to the stage of life we are now 
considering. Indeed, we might say with more force, since, joined 
to the pressure so earnestly deprecated, we must add the almost 
incessant muscular exertion to which children yield themselves 
at this particular time, by which the liability to rupture must be 
increased; and especially at this time the parts give way with 
proportionable facility. 

838. We, therefore, consider the loose dress now in use for 
females, and the almost universal recourse to trowsers and sus- 
penders, for boys, as contributing much to their general health, 
besides very much diminishing the risk of the accident at which 
we just hinted. On these accounts, we would earnestly recom- 
mend it to every mother so to dress her children as shall prevent 
every possible risk of too strong a pressure upon the parts desig- 
nated. 

Sect. II. — The Quantity and Quality of Qlothing. 

839. The errors committed on both these points are not less 
frequent than obvious ; they consist chiefly in extremes : theory 
in most instances directs both, and too often in direct violation 
of reason and experience. One extreme here alluded to is ad- 
vocated by a class who suppose that the body can scarcely be 
covered too thinly, for the purpose of giving strength to the 
constitution ; hence, let the inclemency of the weather be what 
it may, they banish nearly all the warmer articles of clothing, 
with a view of inuring the body to any temperature to which it 
may be exposed. The other class consists of those who appre- 
hend cold to be the most destructive agent that the human body 
has to contend against; hence, whenever their pupils are exposed 
to an out-door atmosphere of a reduced temperature, care is 
taken to protect them against the mischievous tendencies, which 
their apprehensions have conjured up, by every adventitious 
means that wool and fur can supply. Both these plans must 
necessarily have their victims ; and it is, perhaps, a moot point, 
which of the two is more destructive. We have already dwelt 



220 OF DRESS. 

upon this subject on another occasion: and what we have said 
there will strictly apply here. 

840. Our mutable climate, or rather our climate, which at 
one season has the heat of the tropics, and in the other the cold 
of the frozen north, requires corresponding changes in clothing 
at those different periods. In summer our feelings oblige us to 
reject all superfluous covering; and in winter they make us 
covet the warmest garments — there is but little risk, in general, 
in obeying the first impulse; but the second may be carried to 
an extreme, especially in the early part of life. 

841. Exercise, which is so much desired by youth, and which 
is generally so advantageous, will render less warm clothing, 
even during our coldest periods, sufficient; hence, those who are 
habitually exposed to the weather, but at the same time suffi- 
ciently well protected, will require either fewer garments, or of 
less warm materials, than those who are almost constantly con- 
fined to the house, either from necessity or choice ; nor will the 
former be so liable to injuries from the vicissitudes of the wea- 
ther. 

842. This fact is notorious to the observation of every body ; 
yet so unnecessarily apprehensive are some, that they oblige 
their children to clothe themselves as w r armly, w r hen they are in 
the full exercise of their limbs at their various sports or avocations, 
as if they were about to perform a journey in a slow-motioned 
stage-coach or wagon. The consequences of this over-clothing, 
under such circumstances, are, croup, pleurisy, or catarrhal fever, 
from a suddenly checked perspiration, which had most unneces- 
sarily been excited by a superfluous quantity of clothes. We 
have already remarked upon the other extreme. 

843. Too strictly guarding the neck and throat of boys should 
be particularly avoided; for, from the proximity to the seat of 
circulation, they very quickly have their heat unduly increased 
by an over quantity of covering; to relieve which the articles 
surrounding them are suddenly removed, perspiration becomes 
checked, and disease, of course, follows. Therefore, those parts 
should be but moderately clothed, that the consequences just 
spoken of may not follow. 

844. Custom, among females, has almost deprived them of 
any protection to these parts, or even to their chests. This 
exposure to an inclement atmosphere is decidedly wrong; and 
but too often lays the foundation of consumption, or other affec- 
tions of the chest, (459.) We are, however, not to be under- 
stood as advising any unnecessary covering; we would only 
wish to suggest that, when they are exposed to the weather, a 
greater protection should be afforded to these parts than if they 
were within doors. 

845. The head should not be too warmly clad, of either a boy 



OF DRESS. 221 

or girl, especially those who are in the habit of exercising much 
in the open air — nature intended that the hair should serve for 
its protection, particularly within doors. Therefore, children 
should not be permitted to wear their hats or bonnets in the 
house, as there the hair is an all-sufficient covering. In the 
extreme cold of winter the ears of such as are exposed to the 
wind frequently suffer severely — to prevent this, a small piece 
of fur may be adjusted to the hat, so as to cover these parts ; 
or a fur cap may be indulged in, but let it be forbidden to be 
worn in the house. 

846. But in no one particular are the sticklers for the hard- 
ening system more in error, than when they reject stockings 
in cold weather, and even in winter. We cannot refrain from 
expressing our surprise that this absurd and cruel practice could 
ever obtain, since there are no portions of the body more liable 
to suffer than the feet and legs, and few that have a larger circle 
of sympathies connected with them. We, therefore, constantly 
recommend that these parts should be kept covered by a suffi- 
cient protection by stockings and shoes. We say that a sufficient 
protection should be given to these parts ; for we are aware, that, 
like the coverings for other parts of the body, it maybe overdone. 
In winter, the shoes can scarcely be too stout; not by their 
thickness to increase warmth, but to protect the feet against 
wet. The stockings may be of worsted ; but these should not be 
too thick. If the stockings be too thick, they excite too much 
perspiration, and the consequence is cold feet. 

847. We have already remarked upon the propriety of keeping 
young children sufficiently warm in every respect ; and of the 
necessity of accommodating their clothing to the vicissitudes of 
the weather ; but we do not wish to be understood that this 
system should be extended in all its details to children of greater 
age — that is, to children of the period of which we are now 
treating ; for, after the fifth year, it is well to inure them to the 
changes of an external atmosphere, by often repeated but not 
too long continued exposures. A person of but common obser- 
vation, who has an interest in the child, will easily perceive when 
the cold becomes severe, by its complainings, as well as by its 
appearance — when this happens, the child should be immediately 
removed to a milder, but not suddenly to a heated atmosphere. 
In these little but important trials, the child should never remain 
passive for any length of time—if not of itself disposed, it should 
be induced, by various little stratagems, with which every good 
nurse is acquainted, to put its little body in motion, that the 
circulation may be equally maintained ; but if it cannot be excited 
to activity, let it be taken into the house. 



PART III. 



CHAPTER I. 



OBSERVANCES FROM SECOND DENTITION TO PUBERTY. 

848. It is impossible to treat this part of our subject without 
constant reference to certain directions which have already been 
given for the promotion of the general well being of the child. 
Up to the period, therefore, now about to be considered, we are 
supposed to have directed the best physical treatment in our 
power; that is, we have endeavoured to avail ourselves of the 
experience of others, as well as of our own, to give the best 
possible chance of a healthy, regular development of the system, 
by urging such observances and directions as have been found 
best calculated for this important purpose. 

849. We shall not, therefore, repeat in detail, the directions 
for eating, drinking, sleeping, exercise, &c. ; but merely state, 
that, as the body is still in a state of gradual development, as 
much care is necessary at this period, for the continuance of the 
system already commenced, as in the earlier parts of life. In- 
deed, it may be said with much propriety, that as the individual 
is now left more to his own guidance from his increase of years, 
it behooves him, by cautious conduct, that he defeat not the 
good already received from the government of watchful parents, 
and thus irretrievably destroy his health. Boys, at this period 
of life, are necessarily less under the eye of the parent than 
girls ; consequently, more vigilance is required with regard to 
them. To render, therefore, any directions efficient, such a 
habit of obedience must have been created by previous moral 
discipline, as will render the will or commands of the parent 
availing; or all that has been before done will be lost. 

850. Should children, from heedlessness or perverseness, at 
this period of life, fail to continue the plan previously adopted 
for their benefit, they will be sure either to call into action some 
latent predisposition, if such exist, or lay the foundation for 



224 FROM SECOND DENTITION TO PUBERTY. 

future ill health ; as this period, like that of dentition, is marked 
by peculiar susceptibilities, and is thus rendered more obnoxious 
to disease. We shall, therefore, say a few words upon the leading 
points of physical education, that we may not be misunderstood 
in respect to that we would wish to enforce ; and, 

851. 1. Of Eating. — If the physical treatment have been 
previously well begun, it will be found at this time that the ap- 
petite and digestion will be in just proportion; for the body 
lias now acquired more vigour, and the play of the muscular 
system is more confirmed, and better balanced; consequently, 
the stomach will have an increase of power, and will perform its 
offices with as much facility as success, provided it be not over- 
taxed by the quantity of food, or that this be not of an improper 
quality. But, unfortunately for this period of life, children, as 
we have already observed, are less under the eye of the parent, 
and are but too apt to abuse this organ, either from a certain 
craving for improper articles, or a recklessness of consequences, 
however affectionately forewarned — hence, but too often, a foun- 
dation is now laid for future disease of the stomach. Sometimes, 
indeed, parents themselves are not sufficiently upon their guard; 
they permit, but too often, the full indulgence of the appetite, 
from a persuasion, or rather from an unfounded hypothesis, that 
"children never eat more than is good for them." 

852. This unqualified assertion is contradicted by daily expe- 
rience; and, therefore, deserves the serious consideration of 
parents. They should learn to distinguish between the demand 
of a natural and healthy appetite, and the cravings of habit; or 
they will discover, too late, that the powers of the long-suffering 
stomach are destroyed, never again to be restored. There is no 
point of treatment more easily complied with than this, provided 
the parent, or a judicious and faithful servant, take charge of the 
child during its meals, and become the judge of both quantity 
and quality. We shall, therefore, lay down the following rules 
for eating: — 

853. (a) Children should never be suffered to eat alone, unless 
the proper quantity of food be apportioned to them. 

854. (5) If a child demand more than is judged proper for it, 
resist, at once, its importunities with firmness, or you will but 
too certainly make it a glutton. 

855. (c) As every extraordinary particle becomes a new in- 
centive to appetite, as little variety as possible should be set be- 
fore children. 

856. (d) Children should never be indulged with a second 
course; since, if they sit down with an appetite, they will gene- 
rally satisfy it by eating freely of the first articles presented to 
them ; consequently, all the rest is superfluous, and, therefore, 
injurious. If the appetite be small, the less they eat at that 



OF EATING. 225 

moment the better; as, by taking but little, the appetite will be 
sure to return at the next meal. But, should this instinct of 
nature for an observance of moderation be neglected, or be at- 
tempted to be overcome by variety, repletion, with all its evils, 
will follow; therefore, instead of a renewed and healthy appe- 
tite following, as it would necessarily have done had the instinct 
been obeyed, it will be found diminished ; and most probably 
attended with headache, oppression, or even vomiting. 

857. (e) The food for children at this period, should be of the 
most simple, and digestive kind. The breakfast should be of 
milk, with bread, mush, rice, &c. ; or, of very weak tea, with 
much milk, bread and butter, and a soft-boiled egg. The dinner 
may consist of plain boiled or roasted beef, mutton, chicken, 
&c, or the soup of either, divested of fat. The vegetable, (for 
there should never be more than one at a time,) may be the 
Irish potato, rice, hommony, Lima beans, or beets. This plain 
food will be every way sufficient for all useful purposes : — more 
than this will be excess, and should, therefore, be prohibited. 
The supper should be similar to the breakfast. 

858. (/) Children should never be indulged with pastry of 
any kind — they may, occasionally, take a little of the cooked 
fruit of a pie, but even this should be used moderately. 

859. (g) Children should not be indulged with bread, bread 
and butter, &c, between meals, however hungry they may seem 
to be : for this will either destroy the regular appetite at dinner, 
or they will eat too much. In the first case, the stomach will 
be interrupted in the regular routine of its functions ; conse- 
quently the appetite will become either irregular or whimsical, 
both of which must be avoided; in the second case, all the evils 
consequent upon an over-distended stomach must follow. 

860. (h) Children should never be permitted to exercise vio- 
lently immediately after dinner; therefore, this meal should be 
presented to them soon after school hours ; and they should be 
made to remain passive; or, at least, all severe exercise should 
be forbidden until they return to their school. 

861. (i) Children should be taught the importance of eating 
slowly, and chewing their food well — on this account a habit of 
resting after eating should be early established, that they need 
not swallow their meals hastily to return to play ; or, in, other 
words, this should never be permitted. 

862. (k) Children of the age of which we are now speaking, 
may occasionally be indulged in small quantities of almost any 
of our fruits, provided they be perfectly ripe. 1 The most pro- 

1 Children, at the period of life just named, are more frequently and seriously 

injured by eating unripe fruit, than is generally imagined. There is, to a child's 

stomach, an irresistible charm in fruit of every description; and they will but 

too often procure it, coute qui conte. Having no guide but their inclination, thev 

15 



226 

per time for this is when the stomach is in full possession of its 
powers, or an hour before dinner. The reason for the selection 
of this time is obvious : the stomach is now empty or nearly so, 
and the gastric juice is in considerable quantity; for we have 
already observed that fruit is not very easily assimilated. 

863. (I) Children should not be suffered to carry food in their 
pockets, to eat between meals, or during school hours; as the 
bad habit of requiring food at improper times is produced, and 
the digestion of the previous meal is interfered with by a fresh 
quantity being thrust into the stomach before it has properly di- 
gested that which had before been received. 

864. (m) Children should get their breakfast as soon after 
they have properly washed and combed themselves, as may be 
— as their stomachs are now empty, and plentifully supplied with 
gastric liquor. If left too long without food, the cravings be- 
come either too importunate, or the appetite fails — either of 
which would be injurious. 

865. 2. Drinking. — There is but one drink really proper for 
children; namely, water. In this they may be as freely in- 
dulged as the necessities of the stomach may require ; but they 
ought not to be permitted, upon every pretence, to drink between 
meals, lest a disagreeable and mischievous habit be generated, 
and the stomach made to suffer. During meals, or soon after, 
they may drink water to advantage ; but to encourage the habit 
of drinking between every mouthful they swallow, is bad. The 
stomach becomes unnecessarily distended by quantity, and dis- 
tressed by weight ; and the digestive menstruum impaired in 
power by over dilution ; consequently, the process of assimilation 
will be imperfectly performed. 

866. 3. Sleeping. — This all important restorative should be 
regulated with the utmost care. Its periods should be disturbed 
as seldom as possible ; and the child should be permitted to en- 
joy its full proportion, and this without interruption, if possible. 
Some children require more sleep than others; it is, there- 
fore, a useful study to ascertain the proper quantity each indi- 
vidual should employ. To determine this, we must be attentive 
to the habits of every child; and that one which expends, by 

will eat of it even to surfeit, if able to procure it. Parental admonition would 
effect much on this important point, were it enforced by command, or even 
strengthened by example; but, unfortunately, too many parents are either indif- 
ferent to what their children eat, or think it right they " should be able to eat 
of any thing." It is in vain, then, to rely upon parental authority to remedy this 
evil ; we must look to the civil power for its cure; and it is truly an object worthy 
of their most serious deliberation, to remove, by a law, regularly and severely 
enforced, all the unripe trash which so abundantly fills our market. Every kind 
of fruit offered for sale should be rigidly inspected; and if it be found immature, 
it should not only be forfeited, but the vender severely fined — this would effect 
much more good than the seizure of a pound of butter, because it lacks half an 
ounce of the standard weight. 



OF EXERCISE. 227 

any means whatever, the most strength during the day, requires 
most sleep during the night to restore the lost quantity. We 
may, therefore, lay down the following rules for sleeping. 

867. (a) Every child should go early to bed, that the due 
quantity of sleep may be certainly procured — by early we mean 
immediately after candle light in summer, and not later than 
eight or nine in winter, for a child not exceeding seven; and a 
little later for one more advanced. 1 

868. (5) Sleep should be so regulated as not to interfere too 
much with the hours after daylight — therefore, the old saw of 
"early to bed, and early to rise," &c, is one of great moral 
meaning, and of great practical usefulness. 2 

869. (<?) Children should not, however, be put to bed imme- 
diately after a full meal — it would be proper, if any thing has 
prevented its taking supper at the regular and proper time, that 
the sleeping hour be a little retarded. 

870. (d) Children should never be unnecessarily or suddenly 
awakened, lest their nervous system be thrown into disorder by 
the alarm. 

871. (e) Children should be accustomed to sleep in the dark, 
both from a moral and physical propriety — they should not fear 
the dark ; nor should their sleep be interrupted by the presence 
of light. 

872. (/) Children should not be permitted to indulge in bed 
long after daylight, as its warmth, the accumulation of urine 
and faeces, and the exercise of the imagination, but too often 
lead to the precocious development of the sexual instinct. 

873. Sleep is not only useful in restoring lost energy, but it 
is, also highly important to growth. It is a well established 
fact, that there is a considerable difference irrthe stature, espe- 
cially of young people, between the morning and evening. This 
arises from the superincumbent weight producing an approxima- 
tion of the vertebrae ; consequently, an opportunity should be 
given to them to expand again, which they will do by their own 
elasticity, as soon as they have the opportunity, by the weight 
of the body being taken off by a recumbent posture. 

874. 4. Exercise. — In proportion as the child advances in 
age, will be his desire for employment; hence, the multiplication 
of his amusements. Every proper opportunity, therefore, should 

1 It would be difficult to fix, by hours, the precise time a child should sleep, as 
it must, in some measure, depend upon constitution, as well as upon exercise and 
mental exertion. In general, we may say, that a child of seven years old might 
safely indulge in nine hours of sleep; and from that period to manhood eight 
hours may be safely allowed. 

a Children should not be played with after they are in bed ; sleep, like every 
other function of the body, has its periods : should this be incautiously inter- 
rupted, the child may remain wakeful during the whole night, and be thus unfitted 
to rise in proper time in the morning. 



228 OF EXERCISE. 

be given for the due exercise of both body and mind ; but nei- 
ther should be too much fatigued. Care should be taken, at this 
period, to provide such employment or amusement as shall exercise 
the arms as well as the limbs; of this kind is battledoor and shut- 
tlecock, playing at ball, pitching of quoits, &c, for the period is 
now fast advancing for the completion of the human body ; and its 
proper development very much depends upon uniform exercise. 
Therefore, all such employments as but partially employ the 
muscular system, should be changed for those which will call in 
requisition every part of the frame. 

875. After selecting proper games and exercises for children, 
constant care should be taken that none are indulged in to ex- 
cess; for the most innocent and amusing, if carried too far, may 
become a source of extensive mischief; therefore, amusements 
of every kind may be converted into evils. But let us not deny 
ourselves the advantage of such employments, because they may 
be abused. Let us only be judicious in choice, and set proper 
bounds to indulgence, and there is little to fear from the exer- 
cises of youth. 

876. Again, in choosing amusements, let them be well adapted 
to the individual for whose benefit they are intended — thus, every 
boy cannot become a good fencer, a good dancer, a good runner, 
and a good leaper; yet he may excel in some of these amuse- 
ments. His disposition and skill for any particular species of 
amusement should be studied ; and he should only be kept at 
such as will give him a chance of not falling below mediocrity. 
If this be not attended to, he may become listless and supine; 
and receive injury from that which was well calculated for his 
benefit, by his self-love being mortified by the superior skill and 
address of his companions. 

877. All hazardous experiments of skill or strength, should 
be peremptorily forbidden — all attempts at posture-making are 
highly dangerous, and should not be reckoned among the proper 
exercises of youth. Every violent exertion must necessarily be 
attended by a proportional strain upon some one part or other 
of the body ; therefore, it should be instantly discountenanced ; 
such as jumping from great heights, leaping over elevations; 
lifting great weights, &c. ; for in every exertion of this kind, the 
most serious risks are run of producing a disability for life. It 
is by these hazardous experiments, that "ruptures" are so fre- 
quently produced. 

878. We should, nevertheless, be careful that we do not pro- 
duce timidity by the too indiscriminate reprehension of amuse- 
ments which maybe abused; children should be permitted to 
leap, climb or run to a certain extent ; but only where, under 
ordinary circumstances, no danger can arise. At the same time, 
they should be made acquainted with the mischief which may 



OF EXERCISE. 220 

follow any of these amusements, when carried to excess, or when 
improperly performed. They should be early made sensible that 
lifting weights beyond their strength, throwing the body violently 
and extensively backward, leaping over high places, or jumping 
down very low ones, &c, may in a moment produce a " rupture," 
and disqualify them through life for any active employment. 
On this account, the exercises of a well regulated gymnasium 
become so valuable, as the performances are graduated; begin- 
ning with the most easy, and progressively arriving at the most 
difficult. 

879. Very often at this period of life strong dispositions are 
discovered for mechanical employment: whenever these are of 
a decisive character, they should be encouraged; for, though the 
individual may never follow the art his early predilection led 
him to select, yet the dexterity acquired in his early years may 
essentially serve him in some future business of life; thus, a 
surgeon has been often benefited by his knowledge of the mode 
of handling tools, &c. Therefore, a boy may often safely and 
profitably be indulged in the use of sharp tools, though it may 
occasion an anxious mother many heart-aches during his initia- 
tion into the mode of employing them. 

880. One general, and we might say essential, rule, should 
ever govern youth in their sports and amusements ; which is, 
never to engage in such as shall require much exertion, after a 
full meal, as the worst consequences may result from the neglect 
of this caution. 

881. It will be perceived that the great object of all physical 
education is the regular and healthy development of every part 
of the body, in its proper order and proportion. When this 
succeeds, the period of puberty advances in regular and unem- 
barrassed order ; and the intentions of nature are fulfilled with- 
out disturbance or disease. The changes in both sexes, intended 
to mark this important period, take place in regular succession ; 
and, when accomplished, mark a new era in human life. And 
most happy should that individual be, who arrives at this period 
without accident, and proves the changes to be complete. 

882. Much care is required at this all important time, that 
neither accident nor design shall interrupt the regular march of 
changes, which precede and announce the completion of the 
human fabric to be at hand. It is a period replete with moral 
and physical difficulties ; and much prudence and good sense are 
required on the part of parents and guardians, that they may 
be both successfully surmounted. It does not enter into our 
scheme to treat this subject either anatomically, by tracing the 
alterations of structure in the parts mediately or immediately 
concerned; or medically, by pointing out the diseases and their 
cure, to which they may be liable. 



280 OF EXERCISE. 

883. Though it does not enter into our scheme to treat of the 
moral discipline of youth, yet we may be permitted to observe 
that much injury is done to them, especially in the very early 
period of their existence, by attempts at precocious development 
of the mental powers, by overtaxing the brain, by presenting to 
it tasks fitted only for riper years. This injurious exercise of 
the mental powers originates in either a mistaken theory or in 
a vanity on the part of the parent, that cannot be too severely 
reprehended. 

884. We once saw a child of twenty months old completely 
master of the alphabet — it was a female, and began to talk very 
early; its mother, with a perseverance and industry worthy of a 
better object, commenced her task of teaching as soon as the child 
could speak ; and, before it was twenty months old it knew every 
letter of the alphabet so well, as not to be puzzled by any strata- 
gem instituted to mislead it. She died a prodigy, at three years 
old, of hydrocephalus internus, or dropsy of the brain. This 
victim of maternal pride was constantly exhibited to every 
visiter, and made to give proof of its precocious attainments, 
until its little brain could no longer resist the repeated shocks 
it was forced to bear for the gratification of the mistaken mo- 
ther's vanity, or to give evidence of its intellectual powers. 

885. To this we may add another error into which parents 
permit their children to indulge at a very early period of life, 
and which, with certainty, lays the foundation of many gastric 
as well as cerebral affections — namely, the use of tobacco in some 
way or other. On this subject we cannot resist the temptation 
to copy Dr. Palmer's eloquent denunciation against the use of 
cigars. 

886. " The young man who, unjustified by the plea of ill health, 
or unsanctioned by the prescription of his physician, has ac- 
quired the habit of smoking a pipe or cigar, may assuredly con- 
gratulate himself on having reached the second stage of his pro- 
gress, from temperance to dissipation — from elasticity of spirit 
and vigour of frame, to premature imbecility and decay. As 
the reckless poacher is led gradually on, from his work of mid- 
night depredation in the woods, to more daring acts of violence 
and rapine, so will tke youthful smoker be too often insensibly 
allured from a wanton indulgence in the cigar to the sins of in- 
toxication, and the ultimate sacrifice of his health, his charac- 
ter, and prospects. Let parents, then, as they appreciate the 
responsibility which devolves upon them, solemnly protest against, 
and resist, the first encroachment of this pernicious habit on their 
family. Let females, whose influence is commonly as beneficent 
as irresistible, exert their powers in decrying the noxious prac- 
tice, and averting from those in whose reputation and welfare 
they are so deeply interested, the moral pestilence. If the 



OF EXERCISE. 231 

leaders of fashion in the land are resolutely bent on destroy- 
ing the little remnant of energy and character which they still 
possess, let them pursue their ignoble propensities, and achieve 
the work of moral ruin, as they are wont to dissipate their for- 
tunes, in private. Society will be disposed to contemplate with 
singular philosophy and forgiveness, any act of moral suicide 
which these 'Spoilers of the human hive,' may be tempted to 
commit. But let them not contaminate with noxious exhalations 
the public atmosphere ; nor the minds of the thoughtless and 
inexperienced, who are, too frequently, by the vulgar ambition of 
aping fashionable follies, with their yet more pestilent example." 
— Illustrations of Medicine, p. 145. 



F THE 

DISEASES OF CHILDREN. 



PREFACE. 



The diseases of childhood have not, until lately, sufficiently 
engaged the attention of physicians, though they have strongly 
claimed it. It would be difficult to explain satisfactorily the 
causes of this indifference : it may, however, we believe, chiefly 
be ascribed to the following facts : 1st. To the practice of mid- 
wifery being confined almost exclusively to women, until within 
the last fifty or sixty years ; by which the physician was thus 
prevented from seeing many of the diseases of children. 2dly. 
In Great Britain, especially, to a by-law of the Royal College of 
Physicians, " by which its fellows are compelled to exclude them- 
selves from practising midwifery," thereby operating like the 
first cause. 3dly. To a belief that the diseases of childhood are 
obscure, or even unintelligible. 4thly. To parents supposing 
that nurses and old women are more conversant with these dis- 
eases than the most enlightened physician ; by which they are 
deprived of the opportunity of studying them with as much dili- 
gence and accuracy as they deserve. 

But, fortunately for this class of sufferers, an almost entire 
change has been effected within the years just stated, by the 
practice of midwifery becoming almost entirely confided to the 
physician ; by the public mind inclining to the belief that the 
diseases of infancy may be understood, by due attention and 
study ; and, also, that there is rather more safety in the pre- 
scriptions of the physician than in those of the nurse. 

In consequence of this alteration in public sentiment, the care 
of the diseases of childhood has been committed to the physician, 
who now has the opportunity of watching them through all their 
changes, from the moment of birth to the period of puberty. 
Hence, we have, within the last few years, some valuable treatises 
upon this subject; so many, indeed, that it may appear to some 
to lead to the conclusion that the subject is exhausted. Under 
this impression, the present undertaking may be thought to be 
unnecessary, or, at least, to require apology. 

In our defence, therefore, we shall merely observe that the 



11 PREFACE. 

science of medicine must necessarily be progressive ; and that 
its advancement must mainly depend upon the improvements its 
respective followers may make, in the exercise of its various de- 
partments ; consequently, each one is bound to contribute his 
mite towards the general benefit. But, as the improvements of 
any individual in the treatment of one or more of the complaints 
of childhood, would scarcely justify the writing of a volume to 
announce them; as they are, for the most part, diffused through 
the journals of the day; it follows, it must become the office of 
some one to collect and embody them, that they may not be lost, 
and, by such loss, society sustain an injury. 

This office has been undertaken by us ; but with what success 
must be determined by others. We hope we are not indulging 
an overweening vanity, when we say, we feel ourselves, to a 
certain extent, qualified for this duty; since more than fifty years 
of our life have been spent in the contemplation of diseases ; and 
those of childhood have claimed a large share of our attention 
during that period. 

We may urge another inducement to this undertaking ; namely, 
that, hitherto, no one on this side the Atlantic has thought proper 
to give to the public at one view the American practice in the 
diseases of children. This supineness of our physicians is no less 
surprising than reprehensible ; especially as many are so well 
qualified by their talents and experience for the task ; and, more- 
over, such strong inducement is constantly held out, by the pe- 
culiar character of our diseases, and, in many instances, by the 
novelty and boldness of the mode of treatment. 

Hitherto we have almost exclusively depended upon European 
publications for information upon almost every subject connected 
with medical science ; and we acknowledge we have received much 
advantage from them, especially from their elementary works; 
but it must not be disguised, that the same advantage has not 
been derived from all their practical works. This has not arisen 
from a deficiency of either opportunity or of talent ; for we con- 
fess both, in many instances, to have been great ; but to the want 
of proper adaptation of their remedies to the state, force, and 
peculiarity of our diseases. For it cannot escape the observa- 
tion of any intelligent practitioner who may have visited both 
countries, how essentially our diseases are modified by climate, 
soil, manners, and habits; and that these modifications require 
corresponding changes of treatment. 

Most of the diseases of this country have a peculiarity of cha- 
racter, an intensity of force, and a rapidity of march, altogether 
unknown to European climates; and, were reliance to be placed 
upon the feeble practice of that portion of the globe, however 
well suited to the state of its diseases, we would but too often 



PREFACE. Ill 

have the mortification to see our patients hurried to an untimely 
tomb. 

The diseases of childhood in this country, like those of adult 
age, require to be met with promptitude, and with adequate 
means: a temporizing treatment suits not their character, and if 
adopted is almost sure to end in defeat. 1 

Besides, the catalogue of diseases of children by European 
writers has, in our opinion, been too much extended, at least for 
this country. Many of the diseases enumerated by Underwood, 
who is certainly one of the best writers upon this subject, are 
entirely unknown here: the study of them, therefore, becomes 
unnecessary, if not mischievous ; since, from the enumeration of 
some general symptoms, one disease may be mistaken for another ; 
or, from an overweening desire of accuracy in classification, 
confusion may be produced, or distinctions without differences 
may be made. This is particularly the case with the diseases of 
the skin. 

In our account of the diseases of childhood we have endea- 
voured to separate the accidental from the characteristic or 
permanent symptoms; and have only detailed such as are known 
to accompany the disease in this country. This determination 
has almost necessarily confined us to the history and treatment 
of such diseases only as exist in this country; and especially to 
those in this part of our continent. Therefore, the history of 
the diseases to which children in Philadelphia and its neighbour- 
hood are liable, will be, we are of opinion, a pretty faithful ac- 
count of almost all in this country; since the heat of our sum- 
mers will have nearly as decided an influence upon their consti- 
tutions as the sun of the Carolinas or Georgia; while the cold 
of our winters will produce consequences analogous to those of 
more northern latitudes. 

At all events, very little mischief can arise from this mode of 
treating our subject, and none which cannot be immediately re- 
paired by any well instructed practitioner; for it will entirely 
consist in the proper adaptation of the remedy to the force of 
disease, taking it for granted he understands its character; and 
in this country this is generally so uniform as not to make him 
liable to much error. 

Indeed, we may safely add that the general simplicity of the 
diseases of children renders their management more easy, as 
well as more certain, than those of adults ; their complaints are 
almost always acute, and of the sthenic kind; hence the neces- 
sity and success of evacuations in almost all of them. 

We are fully aware that the opinion just advanced is not the 

1 This declaration applies rather to the necessity of early attention to the dis- 
eases of our climate, than to any great difference in the natore of the therapeuti- 
cal means. 



IV PREFACE. 

popular belief, particularly in Europe, and especially since the 
promulgation of the doctrines of the ingenious but ill-fated 
Brown. He taught, and it is but too generally believed, that 
their diseases were almost always asthenic, and, of course, bore 
evacuations ill. There is, perhaps, no one error in medical 
science greater or more mischievous than this ; — to it must be 
attributed, mainly, the general want of success in the com- 
plaints of childhood, and the frequent difficulties the physician 
has to encounter in his treatment of them, from the interposition 
of such parents and friends as may have imbibed the same pre- 
judices. 

The experience of every day would prove how well children 
support long-continued evacuations, did we not turn our eyes 
from the useful lesson. Who has not witnessed the long con- 
tinuance of diarrhoea, without producing even weakness, much 
less death? And who has not seen a profuse salivation, of even 
months' continuance, during the agony of teething, without even 
robbing the little sufferer's cheeks of their bloom? Would this 
obtain with the adult ? No ! He would, perhaps, die by the 
first, and certainly emaciate by the second. 

We are well aware of the importance of the views now under 
consideration : we shall, therefore, advance nothing in support 
of them that does not appear corroborated by our own expe- 
rience. For to us there are no positions in medicine more clear 
than that there are few of the diseases of childhood which will 
not yield to well-directed evacuations ; and that, when not thus 
treated, they become not only obstinate, but often formidable. 
We are also equally persuaded that could this view of the cha- 
racter of the diseases of children gain the ascendency in the 
minds of parents, much less difficulty would be experienced in 
the treatment of them, and, consequently, fewer would be called 
to an untimely grave. 

It is well known to almost every parent that danger may await 
the sudden stoppage of a diarrhoea or incipient dysentery by the 
use of astringents; and many have had reason to remember, 
with much sadness of heart, the improper drying up of the dis- 
charge from excoriated ears, especially during dentition; yet in 
each of these instances, did we yield to the popular belief that 
nearly all the diseases of childhood are of the asthenic kind, the 
early exhibition of laudanum, or some other astringent, would 
be proper in the first, and some drying application necessary in 
the second. 

Besides, it has been but too generally believed that the dis- 
orders of the internal organs of children have no distinctive signs 
by which we can determine or fix either the particular part at- 
tacked, or the precise nature of the affection. From this we 
must dissent; for we are of opinion that we can by a careful 



PREFACE. V 

examination of symptoms determine the seat of the complaint, 
and, by the particular state of the pulse, at least determine its 
general character ; that is, whether it be a disease of too much 
or too little action ; and this is the main point of investigation ; 
for it at once enables us to adapt the remedies to the general 
state of the diathesis. For it must be recollected that there 
is so little difference in the general treatment of the inflamma- 
tions of the liver, lungs, stomach, bowels, windpipe, brain, &c, 
that little or no embarrassment can be created, should any 
uncertainty exist a3 to the particular viscera that may be af- 
fected. 

And it must also be recollected that every important viscus of 
the body, in a state of disease, has its corresponding marks and 
sympathies, by which a careful observer may certainly detect 
the organ to which it belongs. We grant that much experience 
and careful observation are required to determine this, as well 
as to become familiar with the diseases of children, and to pre- 
scribe for them with facility and certainty; but this is attainable 
by well-disciplined bed-side observation, and a correct habit of 
thinking. 

The belief that the diseases of children almost constantly pre- 
sent nothing but perplexing obscurity or embarrassing uncer- 
tainty, has much retarded the progress of inquiry, by engen- 
dering doubts of their susceptibility of successful investigation, 
lucid explanation, or useful arrangement, and, of course, that 
every prescribed remedy has but an uncertain aim, and, conse- 
quently, a contingent or doubtful effect. We are far from en- 
tertaining such opinions ; and we are most anxious, so far as our 
feeble efforts may have power, to banish them from the minds, 
not only of the medical practitioner, but of all who may enter- 
tain them — for they are unworthy of the one and painful to the 
other. 

The skepticism of which we are now speaking has almost be- 
come a popular belief, to the serious injury of the class of suf- 
ferers about whom we are so deeply interested. It has made 
many a parent resort to the prescriptions of an old woman, 
rather than to the advice of the regular practitioner, from a 
persuasion her remedies are the safer because apparently the 
more simple ; thus losing precious time or submitting to improper 
treatment. 

Loss of time is often of the greatest possible consequence, 
since it permits a disease of a dangerous character to take an 
insidious, and but too often, a fatal hold, before the danger is 
suspected, or the proper remedy applied. This loss of time may 
consist in a reliance upon an inefficient, or, perhaps, an improper 
remedy, or in the total neglect of any remedy whatever. We 
need only mention the overlooking of hoarseness in the early 



VI PREFACE. 

stage of croup, or the neglect of the proper remedy in dysentery. 
(See Chapter on Croup.) 

How many parents have had reason to repent of the neglect 
of a slight hoarseness, of perhaps even several days' continuance, 
which terminated, in a few hours after it had fully developed its 
character, in death ; and how many, who, perhaps, in some mea- 
sure aware of its tendency, had relied upon a feeble administra- 
tion of antimonial wine, or a little of the expressed juice of the 
onion, when nothing but the prompt application of active reme- 
dies could, even in its commencement, have subdued the disease. 

We have divested our language of as much technicality as 
would be consistent with a work strictly medical ; and we have 
attempted to treat our subjects in as familiar a manner as we 
are capable, without descending to "Domestic Medicine." We 
have also given a translation of our prescriptions, and added a 
glossary of the medical terms ; that those who cannot procure 
medical advice may derive some advantage from them. But let 
us be clearly understood to discountenance, if not absolutely to 
forbid, any interference with the province of the physician, where 
his services can be commanded ; for we declare it is our delibe- 
rate opinion, that much danger may arise from the neglect of it. 

" Ni sutor ultra crepidam," 

is an adage of much pith, as well as of great practical value, and 
we trust we have not violated it. 



OF THE 



DISEASES OF CHILDREN 



BOOK II. 
GENERAL OBSERVATIONS. 

883. Children may be diseased, and even be near death, 
while in utero ; but over such affections we have no control. It 
is, therefore, no way surprising that we should find them occa- 
sionally emaciated, feeble, nearly, and sometimes quite, exhaust- 
ed at the moment of birth. The diseases of children then may, 
with much propriety, be said to commence even before birth, 
though no remedy can be employed for their relief until after 
that event has taken place. 

884. In treating, therefore, of the diseases of children, it is 
proper to commence our account with the affections which may 
declare themselves immediately after they are presented to the 
world ; and these will consist in either the entire absence of re- 
spiration or its imperfect establishment. 



CHAPTER I. 

OF THE ABSENCE OF RESPIRATION, &C. 

885. We are of opinion with Mr. White, Dr. Denman, Bau- 
delocque, &c, that tying of the cord prematurely is very often, 
if not always, injurious to the child. Therefore, it is laid down 
as a rule, and which, we believe, can never with entire safety be 
departed from, that "the cord is not to be tied until the 
pulsations in the umbilical arteries have ceased." Mr. White, 
we believe, first drew the attention of accoucheurs to this point; 
16 



242 OF THE ABSENCE OF RESPIRATION. 

and he has almost universally established an acquiescence in the 
importance of the rule : so general has it become at present, 
that if it were not recommended by any late writer, it would be 
looked upon as an important omission. His opinion on this sub- 
ject is founded upon the most correct physiological views; and 
he must be considered as having contributed much to the benefit 
of society, by the promulgation of a little essay " On the Ma- 
nagement of Children at the time of Birth." 

886. In favour of the practice here recommended there is so 
much concurrent testimony, that we have viewed with regret the 
skepticism of Mr. Burns upon this point. He tells us 1 that 
"when the child is vigorous, and cries lustily, there is no occa- 
sion of delaying, (the tying of the cord,) so long;" and adds, 
"Nor have I ever known any bad effects result from this prac- 
tice." And before, in his text, he declares, — "If it cry, or 
breathe vigorously, then it may be safely separated from its 
mother." These observations go certainly to call in question 
the propriety or necessity of the rule, so well established by the 
experience and reasoning of Mr. White, as well as almost every 
other practitioner. 

887. It is true that Mr. Burns, almost in the same breath, de- 
clares, "When the cord pulsates at the time of birth, we are 
never to be rash in dividing it. It is of importance to keep up 
the foetal circulation till the new mode of acting can be estab- 
lished, and we ought not to divide the cord completely in such 
cases, till pulsation stop." 2 

888. Now, both of these directions cannot be right: on which 
shall the young practitioner rely ? The propriety of Mr. White's 
rule, we think, should never have been questioned; for until it 
be proved an error, it is surely acting on the right side to adopt 
it; for it is not sufficient, to prove it one, that Mr. Burns de- 
clares he never knew any bad effect to result from the practice 
of applying the ligature while the arteries were yet pulsating. 
The evils arising from the practice of applying the ligature too 
early are not always so immediate as to make us challenge it for 
their cause ; and the subsequent ones may be too remote, how- 
ever certain, to be considered as cause and effect. 

889. The author of the little tract alluded to above tells us, 
and tells us we think truly, that "the pulsation of the arteries 
of the cord proves the existence of the foetal life. 3 The exis- 
tence of the foetal life proves the imperfection of the animal 
life. While the animal life is imperfect, the foetal life ought not 
to be destroyed. The navel string, therefore, should never be' 
divided or tied, where there is any pulsation in its arteries." 

2 Principles, Vol. II. p. 9, James's ed. 
*Ibid. Vol.11, p. 11. 

8 The author calls the life of a child in utero the foetal life ; and the life conse- 
quent upon respiration animal life. 



OF THE ABSENCE OF RESPIRATION. 243 

890. Mr. Burns denies the validity of this reasoning, by say- 
ing, "It has been supposed that, as long as pulsation continued, 
the function of respiration was imperfect; but it is not so; the 
pulsation depends more on the continuance of the vitality or 
action of the placenta, than on the state of the lungs." This 
cannot be: the pulsation of the arteries of the cord must neces- 
sarily depend upon those of the heart of the child. This is 
sufficiently proved by observing the mode in which pulsation 
stops in the cord. The cessation commences next to the pla- 
centa itself, and gradually proceeds to the umbilicus of the child 
— this is invariable : now, we would ask, what agency can the 
placenta have in perpetuating the pulsations in the cord, since 
they are always found first to cease next to this mass? We 
grant the agency of the placenta in maintaining the foetal cir- 
culation — but this ceases to be a complete operation before the 
pulsations in the cord cease ; for these are maintained by the 
heart alone, and they would continue this action, did we prevent 
the return of blood to the child by opening the umbilical vein, 
or putting a ligature on it, until its system would be drained of 
almost every drop. 1 But we must not be understood as main- 
taining that the pulsation of the cord depends upon the lungs 
— for we know that when they become perfectly pervious to 
the blood by the new circulation being established, that they 
have a contrary effect — or rather, that the umbilical arteries 
must cease to beat from a necessity imposed by this new condition 
of the lungs and circulation. We must, therefore, hold it im- 
portant that the cord be not tied until the pulsation of its arteries 
ceases. 

891. We have reason to believe we have seen several instances 
of death, and this of a painful and protracted kind, from the 
premature application of the ligature. And that this is probably 
one of the causes of the many deaths, in the hands of ignorant 
midwives and practitioners, we have too much reason to suppose. 
The constant practice of such pretenders is to apply a ligature 
to the cord the instant the child is born ; and this without regard 
to its pulsation, or state of the respiration. 

892. Beyond all doubt, the first great object, after the deli- 
very of the child, is the establishment of its respiration : for the 
most part, this takes place the instant it is in the world ; and, 
indeed, it very often cries, and even forcibly, as soon as the 
head is protruded through the external parts. But should it 
fail to do this, every attention should be immediately paid that 
respiration be established. Indeed, we have heard cries, though 
feebly expressed, before the head has been delivered, and while 
the face was lying on the perineum. 

1 We suppose, in these cases, that the placenta preserves its attachment with 
the uterus, and that the circulation is going on, as before delivery. 



244 OF THE ABSENCE OF RESPIRATION. 

The child may be born in one of the following conditions: 1. 
Feeble, but not exhausted, by either delay in its deliver}', the 
compression of the cord, or from a delicate stamina: these several 
conditions may be attended by a pulsating cord, or one in which 
pulsation has ceased. 

893. In the cases in which the cord still pulsates there is but 
little risk, as long as this action continues ; and, for the most 
part, all that is necessary is to remove all impediments from 
the mouth which interrupt the passage of air to the lungs, and 
by dashing upon its body some cold spirits or brandy : this 
almost instantly makes it send forth cries. But, should there 
be no pulsation in the cord, the child's body flaccid, and espe- 
cially, if upon dividing the funis only a drop or two of black 
blood issues from the cut, the case is desperate, but not abso- 
lutely hopeless. 

894. We should, in this case, 1st, carefully remove any mucus 
that may be in the mouth, fauces, or trachea, by wiping them 
carefully as far as we can reach with the little finger armed with 
a piece of fine dry rag ; 2dly, by inflating the lungs, by holding 
its nostrils, and applying our mouth to that of the child, and 
forcibly expanding its lungs, and then expelling the air from 
them by a gentle, but pretty firm pressure upon the thorax; 1 
3dly, by placing the child's mouth downwards, and holding the 
body and hips higher than the head, at the same time gently 
shaking the child, that it may disengage any mucus that may 
be lodged in the trachea, and permitting it to flow out of the 
mouth, by making it the depending part — then cautiously wiping 
the mouth, as just directed, renew the inflations and the suspen- 
sions alternately, until the mucus is discharged from the mouth : 
by proceeding in this manner, we have often had the satisfaction 
of seeing the child restored. It is a circumstance worthy of 
remark, that sometimes, owing to the tenacity of the fluid within 
the windpipe, we cannot, at first, force air into the lungs ; but 
by a little perseverance, we overcome this obstacle, and the 
mucus sometimes becomes so thinned as to flow readily from 
the mouth, and at once relieve the child. This operation should 
never be neglected; nor should it be too soon given up, espe- 
cially if we can excite a few pulsations in the heart or in the 
cord : these parts should be carefully examined after each infla- 
tion : the pulsation of the heart, when very feeble, is best detected 

1 Mr. Burns recommends "the cartilages of the trachea to be pressed gently- 
back, to obstruct the oesophagus. " (Vol. II. p. 11.) But this is never necessary if 
the head of the child be made to rest upon the right hand, and thrown a little 
backward; for in this position the skin on the fore part of the neck is put a little 
upon the stretch, and made to press against these cartilages, and carries them 
back sufficiently — the fingers of the left hand close the nostrils, while the mouth 
of the operator is applied to that of the child. In this case, the feet of the child 
should be towards the right hand. 



OP THE ABSENCE OF RESPIRATION. 245 

by placing the ear immediately over its region — that of the cord, 
l>y pressing it between the thumb and finger, close to the umbi- 
licus. 4thly, By the application of dry warmth, by means of 
heated cloths, frequently renewed: this precaution should be 
immediately had recourse to, and should be persevered in until 
the last moment. We much prefer dry warmth as an application 
to the child's body, to the warm bath, which is so much relied 
on in such cases — we think we have seen the latter decidedly 
injurious, though we do not pretend to explain the reason. 1 Might 
not a properly constructed syringe be highly useful in moving 
the obstructing mucus ? 

895. When the child shows signs of returning life, it is gene- 
rally by a deep short sob, which may be repeated at longer or 
shorter intervals ; but, when we think the interval too long, we 
should renew the inflations, &c. Should respiration be but im- 
perfectly restored, we must carefully guard against fatiguing 
the child ; therefore, it should not, on any consideration, be dis- 
turbed by dressing it; on the contrary, it should be carefully 
placed in such a situation as to permit the frequent renewal of 
warm applications, which are of primary consequence to it. We 
have more than once had the mortification to find all our endea- 
vours frustrated, by an inattention to our directions upon this 
point, though given impressively. 

896. 2. The child may be born healthy and strong, the funis 
pulsating briskly, yet may not cry, because a mechanical ob- 
struction from mucus prevents the ingress of air into the lungs. 
This mucus may be in the mouth or posterior fauces, or it may 
be in the trachea. If in the first, we may entirely remove it by 
a piece of fine rag upon the little finger, as just suggested; (894) 
if in the second, by suspending the child, as already directed, 
which will seldom fail to give relief, by the mucus being dis- 
charged by running from the mouth. We do not recollect an 
instance where it was necessary to have recourse to inflation, 
while the pulsation of the cord continued; but when it stops 
before respiration is established, recourse must be had to it. 
When the child has made attempts to cry, we may often succeed 
in giving full force to it by dashing spirits or brandy upon its 
body. 

897. 3. The child, from long delay in the passage, or having 
its neck tightly begirt with the cord, may be born, still: in this 
case, its face is livid, or even black, and swollen ; the arteries 
may have ceased to beat, or may beat pretty vigorously. In 
such cases, nothing can save the child from immediate death but 
instantly abstracting blood by cutting the cord. Should the 

1 Does the warm bath invite too much blood to the capillaries of the surface, 
and thus deprive the more general circulation of a portion, that may be essential 
to the proper performance of this office? 



246 OF THE ABSENCE OF RESPIRATION. 

pulsation have ceased, we may sometimes still succeed in drawing 
some blood, by forcing it from the cord with the fingers; and 
then employing inflations, &c. If pulsation continue, we must 
abstract blood by also cutting the cord. The quantity to be 
drawn must be regulated pretty much by the effect. When 
respiration is established, we need draw no more; but until we 
see some signs of this about to take place, we may abstract pretty 
freely, as this process, most probably, is interrupted by the con- 
gestive state of the brain, which can only be removed by ample 
depletion. 

898. This practice of bleeding from the funis, in our hands, 
has always answered a valuable purpose, in the congestive state 
of the brain ; and to such cases it should always be confined. 
Baudelocque recommends this plan; and we can bear witness, 
in many cases, to its entire success; for we have repeatedly seen 
respiration established by this remedy, and by this alone. 

899. Mr. White informs us, however, that he has " repeatedly 
tried this method, and the almost uniform consequence has been 
the death of the child." We believe the cases which proved 
unfortunate in the hands of Mr. W., to have been ill-selected, 
or of so desperate a kind that no remedy could have saved them 
— for it does not follow, because the child has been born still, 
after " a very hard and tedious labour," that it is a case for deple 
tion. And we have farther reason to believe his unfortunate 
cases to have been ill-selected, by his confession that bleeding 
did not always fail. The livid and sivollen condition of the face 
must be present, to authorize the use of this remedy — if they 
be not, we would not feel ourselves justified in abstracting blood. 
Mr. Burns, with a view to get blood, recommends cutting one 
of the umbilical arteries with a lancet or scissors — but we believe 
dividing the cord to be the better plan. 

900. It will always be proper, before the cord is divided, 
to pass a ligature loosely around it, that it may be tied the mo- 
ment we have abstracted a sufficient quantity of blood. We 
should be provided with a diaper, or a white cloth of any kind, 
to receive the blood as it flows from the divided vessels, that we 
may have some means of determining the quantity abstracted. 

901. When respiration has been but feebly or imperfectly 
performed, we think we have seen good derived from a few drops 
of warm wine whey, if at hand, or wine and water. This may 
be repeated every half hour, until it shall be no longer necessary, 
either by the child breathing freely, or by its death. 

902. Mr. Burns thinks, with Dr. Underwood, that, if electri- 
city could be employed, it might be useful. Of this we can say 
nothing from our experience ; yet it would seem to bid fair to be 
beneficial, if time was sufficiently ample to apply it, or if we had 
sufficient address to employ it. But unfortunately a single minute 



OF SYNCOPE, OR FAINTING. 247 

lost is enough to seal the fate of the child. The case stated by 
Dr. Underwood, of the recovery of a child apparently dead for 
two hours, by electricity, should awaken attention to this sub- 
ject. 

908. We have rather dwelt upon this subject, because we feel 
it to be one of much interest — for every one is not in possession 
of the best method of treating still-born, or nearly exhausted, 
children ; yet its importance will be obvious upon a moment's re- 
flection. How often does the life of the child depend upon the 
prompt application of the proper remedies ? Yet how few out 
of the profession are qualified to give it, though the knowledge 
of what is proper upon such occasions is so easily attained ? 
Every mother of a family should be acquainted with the proper 
method of treating children upon such emergencies, since she 
may be so situated as to direct them, either in her own case, or 
in that of a friend. 

904. We will illustrate this by relating a case which fell under 

our notice in the year 1798. Mrs. was suddenly surprised 

by labour in the middle of the night. Her husband was de- 
spatched with all imaginable haste for us, while the lady was at- 
tended to by her sister. The labour advanced so rapidly that 
the child was born before we arrived; and when we handled it, 
it was found to be perfectly dead. We, nevertheless, used all 
our endeavours to restore it ; but they were in vain. We found, 
upon inquiry, that its death was altogether accidental, and it? 
life might have been saved, had its relation but supended it by 
the heels, and well cleared its mouth of the mucus which ob- 
structed the passage of air to the lungs. 



CHAPTER II. 



905. Under this head we may class the condition of some 
new-born children immediately after birth, as well as the syncope, 
properly so called, which sometimes supervenes several days after 
this period. 

906. In the first case, the child seems exhausted altogether 
of muscular power ; it is pale, motionless, and flaccid; it gives no 
other evidence of life than feeble pulsation of the heart and the 
umbilical arteries ; respiration is retarded, and, perhaps, would 
never be established, were the child left to itself. 

907. This condition may arise from the imperfect develop- 
ment of the child itself, though it may be considered as having 



248 OF SYNCOPE, OR FAINTING. 

tarried within the uterus its full time; or it may have been cast 
off prematurely. In both these cases the chance of recovery is 
small, since the want of development is a serious obstacle to re- 
covery; yet, it is not altogether hopeless. 

908. The first object to be attempted in such cases is the ex- 
pansion of the lungs — this must be tried by dashing cold brandy 
upon the body ; maintaining warmth by means of heated cloths ; 
and preserving the funis entire, so long as pulsation continues. 
If we succeed in producing respiration, the child should be so 
placed that it may derive advantage from the repeated application 
of dry heat ; it must be neither washed nor dressed ; and its feeble 
powers must be sustained by the most unremitting application of 
warmth externally, and by the administration of a few drops of 
wine and water, or wine whey, from time to time, internally. If it 
cannot swallow, its lips and nostrils may be every now and then 
moistened with a little wine, or brandy and water. 

909. However unpromising appearances may be in the com- 
mencement of this case, we are justified in saying, that we have 
frequently been rewarded with success by following the plan just 
laid down : it, therefore, always deserves a trial. Should this 
case be mistaken for one in which the brain is in a congested 
state, and treated by blood-letting, it will surely prove fatal ; 
and some of the instances, in which the author of the little tract 
just named tried this remedy, and where the children died, were 
probably of this description. 

910. Children who arrive at their full period will, of course, 
cceteris paribus, stand a better chance than those who are born 
prematurely ; but the latter should never be abandoned, because 
the powers of life are feeble ; especially if they have attained their 
seventh month. We have witnessed two instances of complete 
recovery, where, from all the data we could collect, the children 
had but just exceeded the sixth month. These were neither 
washed nor dressed for many days ; but they were preserved in 
a uniform temperature by means of a stove, and a bed of cotton. 
A few drops of warm whey, from time to time, was all the food 
they received for three weeks, but on which they throve sur- 
prisingly. 

911. One of these children was carefully weighed when it had 
attained its sixth week; its clothing, diaper, &c, and its little 
self, weighed one pound and three quarters. The other was not 
weighed, from a superstitious feeling upon the subject; it lived 
but three months — its death was occasioned by a catarrhal fever, 
contracted from improper exposure. The former is living at 
this moment, and is now a mother of two children. She is still 
small. 

912. There can be no question but the two children just men- 
tioned were preserved by not subjecting them to the fatigue of 



OF SYNCOPE, OR FAINTING. 249 

washing and dressing. They were more than a month old before 
they were exposed to these ordeals. 

913. Children who have undergone their full uterine develop- 
ment, and who would have possessed good stamina, had no acci- 
dent unfriendly to their lives accompanied the labour, may, from 
the nature of such accidents, be liable to this state of exhaus- 
tion. Thus, whatever diminishes the proper quantity of blood 
circulating in their systems, will produce this state of weakness 
— as a separation of a portion of the placenta before birth; the 
placenta being too long, and too powerfully compressed by the 
tonic contraction of the uterus itself; by the cord being slightly 
compressed, when prolapsed, or when it interposes itself be- 
tween the pelvis and the presenting part, &c; hence the fre- 
quency of this state, when the causes just named are known to 
exist. 

914. These cases, if well managed, will very often terminate 
favourably. All fatigue must be avoided, and all purgative 
medicine be withheld. We have never ventured, under such 
circumstances, to purge off the meconium until the child appeared 
to gain sufficient strength to bear the operation without risk, even 
though this required a number of days ; for we believe that this 
substance may occasionally be serviceable in such cases, by keep- 
ing up the stimulus of distention. We may at least venture to 
declare, we have seen the child exhausted in a few hours, when 
several loose stools have followed each other in quick succes- 
sion. 

915. A child so circumstanced should not even be put to the 
breast until its system has become more confirmed by rest and 
judiciously administered nourishment. The milk of the mother 
should be given it by the spoon, and this without removing the 
child from its place of rest ; or, should the mother have no milk, 
a little rennet whey may be substituted ; or, if something a little 
more cordial be thought expedient, weak white wine whey may 
be given. 

916. It now and then happens that a child may be rather 
feeble when first born, but recovers its powers by proper atten- 
tion, and every thing giving promise of doing well — when it sud- 
denly becomes pale, flaccid, cold, with a long interval between 
each breathing, and at last respiration appears to stop; the 
fingers and hands become blue, or black; the lips livid, and the 
eyes fixed, and but half closed; the pulse extinct — in a word, 
looking u the image of death." After remaining in this condi- 
tion for a short time, a slight convulsive motion will appear to 
play about the mouth, an imperfect inspiration will be taken, 
followed by an expiration, attended by a peculiar noise; the 
lips become less livid, as do the hands and nails ; the eyes move 
languidly, and the pulse may now, by close attention, be per- 



250 OF SYNCOPE, OR FAINTING. 

ceived, like a vibrating thread, at the wrist ; an attempt to cry 
is made, but the sound is so feeble that it can be heard only at 
a very short distance — and this finishes the paroxysm. 

917. After the "fit," as it is called, has terminated, the child 
will appear languid and uneasy for some time; it will generally 
swallow, if any fluid be presented to it, provided it be not too 
soon after the paroxysm. A discharge from the bowels of a 
small quantity of a very green fluid almost always takes place 
during the "fit." These spells are repeated at longer or shorter 
intervals, unless the disease be arrested by the influence of re- 
medies, or death closes the scene. 

918. A case of this kind occurred to us, which we will proceed 
to relate; and the mode of treatment will at the same time be 
made known. 

919. Mrs. F. was delivered, on the 13th of March, 1825, of a 
small but apparently healthy child: she supposed she had not 
arrived, by two weeks, at her full period. The child cried dis- 
tinctly, but not very forcibly. It was at the usual time washed 
and dressed, and took without difficulty a little warm molasses 
and water. The next day it appeared to be doing very well; its 
bowels were opened freely, and it sucked when put to the breast. 
It continued to do as well as children in general, for several 
days, (until the tenth,) when it seemed more languid than usual, 
and did not take its nourishment so freely, nor draw so firmly at 
the breast; but as it had had several watery green stools during 
the night, its languor was attributed to this cause. The condi- 
tion of the bowels was but little regarded; as the nurse supposed 
the discharges were not so frequent as to require any medicine. 
In this situation things remained until the following day, when 
the child, after having repeatedly during the morning refused 
nourishment, "fainted," as the nurse called it, and I was im- 
mediately sent for. 

920. When I arrived, the child was in a state of faint, or 
syncope — so completely, however, did it resemble one dead, that 
I thought it was actually so, and expressed a fear to that effect. 
The nurse said, No — it was not dead ; it had only fainted, as it 
had done several times before. I placed my ear over the region 
of the heart, but could hear no pulsation. 

921. I caused flannels to be wrung out of quite warm whisky, 
and applied all over its little body; small sinapisms were placed 
upon the temples ; a drop of brandy was insinuated into its mouth, 
and its nostrils were wetted with a little sharp vinegar. After 
these applications were made, which must certainly, I think, have 
occupied five minutes, the little creature began to discover signs 
of returning animation ; contrary, I confess, to my calculation. 
The return, as it were, to life, was pretty much in the order 



OF SYNCOPE, OR FAINTING. 251 

stated above : the child, however, was found very much exhausted, 
and it was some time before it could swallow. 

922. The bowel complaint was now increased greatly, and the 
poor child nearly exhausted. It had no return of syncope while 
I stayed, which was about an hour ; yet it could hardly be said 
to be alive. I directed the whisky stoups to be continued; and 
a weak chalk mixture, with a little laudanum, was ordered to be 
given every hour, or until the condition of the bowels should be 
improved. A little wine whey, with an equal quantity of cinna- 
mon tea, were directed to be given as often as the child could 
swallow them. 

923. I repeated my visit in the evening. The child had had 
during my absence one "fainting fit," but it did not last so long 
as the former; its bowels were still much disturbed, and the 
child looked more like a corpse than a living being. I desired 
all the previous remedies to be punctually continued. My next 
visit was not until early the next morning. The child had had 
several slight "faintings;" its general appearance I thought 
more favourable; it swallowed with considerable freedom; its 
bowels were much improved; it could cry audibly, and looked 
about with some vivacity. During the whole of this period, its 
little eyes swam in a yellowish fluid, of considerable tenacity and 
quantity — indeed, the quantity was so great as to flow clown its 
cheeks ; and so tenacious as to be traced, through its whole course, 
by the coat which it left upon the skin. 

924. I desired a perseverance in the plan mentioned. From 
this time, it began to recover, and mended rapidly, without any 
return of the faintings. It is now alive, and doing well. 

925. Dr. Underwood recommends, upon similar occasions, a 
more stimulating plan, upon the authority of Mr. Hey, of Leeds, 
such as the volatile tincture of valerian ; and, upon his own, the 
fumes of lighted tobacco forced into the child's mouth. I can 
say nothing as regards the efficacy of either of these plans, from 
any trials of my own. It certainly comes recommended by high 
authority, and should, therefore, be deserving of confidence. I, 
however, confess, that I entertain some apprehensions of the 
tobacco fumes, from its known narcotic powers — but I will not 
oppose speculation to experience. During the severe part of the 
above child's illness, I did not permit it to be dressed — on the 
contrary, it was kept naked, for the better employment of the 
warm whisky. 



252 OF THE MECONIUM. 



CHAPTER III. 

OP THE MECONIUM. 

926. We have, in the first part of this work, (Book I. p. 137,) 
already spoken of the substance called meconium, and of the 
propriety or necessity of purging it off. We shall not repeat 
what we have already said upon this subject, but we may add 
what we did not urge at that time. Since writing what is here 
referred to, a case has occurred, which most decidedly proves the 
necessity, if farther argument were wanting, of carefully and 
completely carrying off this offensive recrement. 

927. A child born healthy had its bowels liberally purged, as 
it was supposed, by the ordinary remedies. It remained per- 
fectly well for several days, and had taken the breast freely. At 
about the eighth day, the eyes and skin appeared rather yellow, 
though its urine was not altered in colour. Its bowels were a 
little affected, and had frequent but very sparing watery stools; 
it hiccoughed often ; its skin was dry and hot ; it became very 
restless, and refused the breast, though evidently very thirsty, 
as it would receive with greediness water, or any other thin fluid, 
from a spoon. It would often start, and at such times would 
move its limbs violently for half a minute together. Its tongue 
was very white, and loaded with a substance resembling a stratum 
of coagulated milk. It did not vomit, though evidently distressed 
at stomach, as it would frequently gag, but could get nothing up. 

928. Believing its distress to arise from some irritating cause 
in the first passage, we ordered a tea-spoonful of warmed castor 
oil; and this to be repeated in two hours, if the first did not 
succeed. A second, and a third, were given, without moving the 
bowels. Magnesia, in five grain doses, followed by a tea-spoonful 
or two of lemonade, were then given. It took a scruple of this 
medicine, with no better effect. Its stomach now began to re- 
volt at every thing that could be offered it ; and the purgative 
medicines were in consequence suspended. The abdomen began 
to swell, and became very tense and shining. It could lie but 
on its back, with its little legs drawn close up to the belly, and 
was evidently in a state of great suffering. Its cries were piteous 
and incessant; and its whole skin became bedewed with a cold 
sweat. 

929. Injections of various kinds were thrown up the rectum; 
the child was placed in the warm bath ; but no stools were pro- 
cured, for the little tinged mucus which came away every now 
and then, by severe straining, did not amount to a stool. We 
had, upon several late occasions with children, found a solution 



OF JAUNDICE. 253 

of' the carbonate of soda very useful in aiding the operation of 
medicine, in cases of constipation ; we accordingly determined 
to administer a grain of this article in a tea-spoonful of luke- 
warm water, every fifteen minutes, until ten grains should be 
taken. 

930. At the expiration of two hours and a half, the bowels 
began to move ; and in the course of three or four hours, there 
were ten evacuations, each of which evidently contained a quan- 
tity of the meconium, with the exception of the first two. The 
purging was now kept up by an additional tea-spoonful of castor 
oil, and was permitted to go on until the meconium was no longer 
visible in the evacuations. Dr. Underwood gives a similar history, 
but one in which a much larger quantity of medicine was exhi- 
bited. 

931. We have related this case with several views : — 1st, to 
prove the necessity of purging off the meconium ; 2dly, to show 
that this substance, when not completely carried off, will most 
probably create a good deal of distress, or even severe disease ; 
3dly, that though the meconium may disappear from the early 
evacuations of the child, it is no proof that there is none re- 
maining; 4thly, that while it has possession of the bowels, it 
prevents, by its tenacity, the usual action of purgative medi- 
cines; 5thly, that by the exhibition of the soda, some change 
was effected in the bowels, favourable to the operation of the 
remedies previously exhibited. 



CHAPTER IV. 



OF JAUNDICE. 



932. The skins of newly born children are frequently of a 
yellow colour; but this does not constitute the disease in ques- 
tion. The yellowness here spoken of is not of a deep tone, 
though very generally diffused. This appearance may continue 
for several days, and then disappear without the aid of remedy, 
or without leaving any evil behind. It is difficult to say to what 
this yellow tinge may be owing ; certain it is, it is not attributa- 
ble to the presence of bile ; since neither the urine, nor the whites 
of the eyes, assume the yellow hue. 

933. We know that changes from a white to a yellow skin 
take place upon certain occasions, and this sometimes with sur- 
prising rapidity, by some occult change in the cellular mem- 
brane or rete mucosum, without our being able to declare the 
cause. This is remarkably the case in yellow fever, where the 



254 OF JAUNDICE. 

presence of bile cannot be detected in the circulating fluids. 
The same thing takes place with certain people, from strong af- 
fections of the mind, peculiar derangement of the stomach, or 
from the bite of certain reptiles, without the aid of bile : it also 
occurs, occasionally, with the new-born child. 

934. Therefore every yellowness of skin must not be mistaken 
for jaundice, as it would lead to great errors in practice. Our 
attention is frequently drawn to this appearance by nurses; and, 
when it is observed, we make it a rule to investigate the condi- 
tion of the child, lest a real jaundice be present. 

935. We direct our attention, 1st, to the whites of the eyes, 
and the secretion of tears ; if neither of these be tinged yellow, 
we have reason to believe there is no jaundice : but if they be, 
we inquire, 2dly, into the appearance of the urine and faeces. 
If the first be yellow, we suppose it a still stronger ground of 
belief that there is jaundice ; and if the faeces be paler than 
they should be, or of a clay colour, we are sure the child has a 
genuine jaundice. 1 

936. We have, however, known all the marks or signs of jaun- 
dice to exist, (with the exception of the pale or clay-coloured 
stools,) without the child appearing to suffer in the least. They 
have all disappeared spontaneously, or by the exhibition of a 
single dose of castor oil, without being followed by the slightest 
inconvenience. As long, then, as the stools are dark green, or 
yellow, we need not give ourselves any anxiety about the yel- 
lowness. 

937. But if, on the contrary, the above marks be attended by 
deficiency of colour in the stools ; if the bowels be costive or 
irritated to frequent efforts; if the abdomen swell, and become 
tense; if the child be uneasy, fretful, and inclined to vomit; if 
it really vomit a white glairy mucus; if it refuse the breast, and 
frequently moan, as if in pain; if it hiccough, and emaciate 
rapidly; if its eyelids become glued together by a yellow tena- 
cious serum, jaundice, in its most formidable form, is present. 

938. In cases of this kind the liver itself has sometimes been 
found much diseased, as in the case related by Mr. Pearson, 
(Underwood, p. 14;) in other instances, the common duct has 
been obstructed, as in the jaundice of adults. 

939. Dr. Underwood, (p. 13,) says, "I have found suckling 
in that state, (with jaundice,) is capable of communicating the 
true jaundice to a great degree, and that it will not be cured, 
but by the recovery of the suckling mother or nurse, or the 
nurse changed, or the infant being weaned, as well as properly 
treated." We think the Doctor must labour under an error in 

1 Dr. Stokes informs us that genuine jaundice has occurred where there was 
no obstruction in the biliary ducts, and that the stools had their due quantity of 
bile. — Stores' Clinical Lectures. 



OF JAUNDICE. 255 

this statement. We have no difficulty in believing that the 
serum of the child's blood may become tinged with bile, since 
the milk it sucks is coloured 1 by it — consequently, the chyle also 
will be coloured: hence, some of the common marks of jaundice 
will be present — that is, the whites of the eyes, the skin, and 
the urine, will partake of the same general hue with the serum 
of the blood, but the essential mark of jaundice, we are sure, 
will be wanting; namely, the light or clay-coloured stools, or the 
absence of bile in them. It would be extremely difficult to con- 
ceive how the tinged milk of the mother should either materially 
injure the liver or obstruct the common duct; and, unless one 
or the other have happened, we believe a genuine jaundice can- 
not be produced. 2 

940. Nor is there any difficulty in accounting for the yellow 
appearances of the child, or that it .shall not get well, (that is, 
lose its yellow appearances,) until the mother or nurse is cured, 
and the child is weaned, since it is constantly receiving the same 
coloured milk. 

941. When a genuine jaundice attacks a new-born child, it is 
but too often fatal, with whatever propriety or energy we may 
attempt to relieve it. It is generally recommended to com- 
mence the cure by an emetic: for this we have the authority of 
Armstrong, Underwood, Burns, &c. : to oppose our single ex- 
perience against them, might appear ill-judged, if not rash. 
Yet we dare not run counter to our own observations ; especially 
as we have given fair trials (in our own estimation,) to the 
remedy, and the result is decidedly against the practice. 

942. Emetics have not only failed in our hands to remove the 
disease, but have rendered the stomach so irritable as not to re- 
ceive any other remedy willingly. We have, therefore, aban- 
doned them for some years, and find w x e can succeed better by 
another plan of treatment. 

943. When we find symptoms of jaundice, that is, yellow skin, 
eyes, and urine, we begin by giving small doses of castor oil; 
that is, a small tea-spoonful every two hours, until it purges freely. 
If, upon the inspection of the evacuations, we do not find bile in 
them, we follow up the purging the next day, by giving calomel 
in very small doses, until a cathartic effect be produced. This 
may, and does require, sometimes, two or three days' perseve- 

1 This is very questionable; since Dr. Stokes informs us it has never been ob- 
served in the milk, agreeably to recent and extensive observations.— Stores' 
Clinical Lectures. 

* The serum of the blood does not always become affected, even in true jaundice. 
I have lately had a patient who was suckling the whole time of the disease, yet 
there was not the least evidence of the milk becoming tinged with the colouring 
matter of the bile, though I carefully examined it, from time to time, through 
the whole course of the complaint. Nor did the child in any one respect appear 
to suffer. 



256 OF JAUNDICE. 

rence in the calomel, aided by small doses of soda, supersatu- 
rated by carbonic acid gas, before the bowels are moved ; for 
it must be recollected they are most commonly very torpid. We 
have said we give calomel in very small doses; the following is 
our formula: — 

R. Calom. ppt. gr. iij. 

Sacch. alb. gr. vj. 

M. bene, div. in xij. 

944. One of these to be given every two hours, until they 
operate. They are best exhibited in a small drop of thin molas- 
ses, washed down by the solution of soda, in the proportion of 
two scruples to eight ounces of the carbonated water. 

945. A tea-spoonful of the solution of soda may be given fre- 
quently as a drink. Should the calomel, at any time after ex- 
hibition, procure bilious evacuations, it should be desisted from, 
or given less frequently. But, should it not, it must be perse- 
vered in, unless the bowels become too much irritated ; in this 
case, they must be appeased by laudanum, in quarter drop doses, 
every two or three hours, until the effect be produced. During 
this period, however, the solution of soda should be continued. 
We have thought that advantage has been derived by bathing 
the abdomen with warm brandy, especially if this part be preter- 
naturally hot or cold. In doing this, however, a caution must be 
suggested that the parts be not unduly pressed or rudely handled, 
under the impression that this is essential to its efficacy. 

946. Should diarrhoea, with bilious-looking or watery stools, 
supervene, the calomel must be stopped, and laudanum must be 
given, as directed above. During the whole of this time, the 
child should receive its mother's milk as often as it well can, by 
sucking, if able ; or by the spoon, the milk having been previ- 
ously milked out. 

947. We have thought, also, that the occasional employment 
of the warm bath has been useful, especially when there is a dis- 
position to spasm or frequent hiccough. 

948. But, notwithstanding the employment of the above re- 
medies, if the stools do not become bilious; if the tone of 
yellow in the skin be increased, or rather looking black ; if the 
skin become mottled ; the eyes blood-shotten ; the urine very 
scanty, and very high-coloured; or if entirely suppressed; the 
hands and nails looking livid; if the child vomit, or be threat- 
ened with convulsions, the case must be considered as extreme- 
ly desperate, though not absolutely fatal, as we once witnessed 
a case where all these symptoms were combined, yet the child 
recovered. 

949. In the case just alluded to we used, not knowing what 
else to do, but almost solely with a view to relieve the anxiety 



OF ERYSIPELAS. 257 

of the parents, a warm bath every two hours, for five minutes at a 
time, in which an ounce of the sweet spirit of nitre was mixed. 
After its first application, the child appeared revived ; and 
each subsequent one was followed by improvement — bilious eva- 
cuations took place ; there was a liberal secretion of urine, and 
the child mended from that moment with astonishing rapidity — 
we do not, however, wish to attach much consequence to this 
first trial — it was, perhaps, mere coincidence. It may, however, 
deserve farther trial: — we have not ourselves had an opportunity 
to repeat it since. 



CHAPTER V. 

OF ERYSIPELAS. 

950. Children in the month are sometimes liable to inflam- 
mation of the skin of the erysipelatous kind, which locates itself 
variously. It is not, however, a very common affection, espe- 
cially among the higher classes of society. It is a disease of 
more frequent occurrence, it would seem, in Europe, and espe- 
cially in the lying-in hospitals, than in this country. 

951. When this complaint is a symptom of some prevailing en- 
demic of crowded hospitals, it is considered by both the French 
and English writers as one of great danger. Dr. Underwood 
says he has not met with this disease often, except in lying-in 
hospitals. Its ordinary time of attack is a few days after birth ; 
and was thought, by some, never to appear later than the month 
— but he says this is not the case; and this agrees with our own 
observations. 

952. We have seen this certainly later than the third month ; 
and in one instance, and that one of a most ferocious kind, the 
child was beyond the sixth month. It would seem that no part 
of the body is exempt from an attack of this inflammation ; at 
least, we have seen it commence upon various portions of it. In 
the instance just alluded to, it might be said to have had no " lo- 
cal habitation;" for we saw it occupy a leg, a thigh, an arm, the 
face, or the body, in the course of twenty-four hours. 

953. Its translations were rapid, beyond belief; and the part 
occupied at one moment would, in another, be left free from dis- 
ease; while a new portion of the body, uncertain which, would 
be obliged to sustain its attack ; which in its turn, in the course 
of two or three hours, might be left, with equal capriciousness, 
to fix upon some new part, without the one just left having re- 
ceived any material injury. The inflammation, in this instance, 

17 



258 OF ERYSIPELAS. 

did not vesicate until it had fixed permanently upon the head 
and face; which it did, after having pursued this erratic course 
for five days. After the head and face became affected, the 
disease seemed to forget its fugitive course, but not its deadly 
character. The face and head became immensely swollen; the 
surface attacked became purple, and vesicated over its whole 
extent ; delirium followed, and death soon closed the scene. 

954. The places most commonly selected for this inflamma- 
tion, agreeably to our experience, are the nates, the neck, the 
small of the back, 1 and face. It usually begins by a spot of un- 
certain size and ill-defined extent. Fever is almost sure to at- 
tend ; 2 and the child to betray great marks of suffering. The ex- 
tent of the inflammation may be very limited for several hours, 
or even days, unless it vesicate early: when this happens, the 
disease spreads with much greater rapidity, and suddenly be- 
comes dangerous. The stages of this inflammation are some- 
times passed with great rapidity: a bloody, ill-looking pus, or 
ichor, is quickly formed, which very soon extends itself through 
the meshes of the cellular membrane, to an undefined distance. 

955. Whenever this inflammation extends to the cellular tis- 
sue, it is sure to destroy it, by forcing it to a rapid suppuration, 
and thus divesting the parts of this important membrane. Ab- 
scesses, or rather collections of matter, are, therefore, formed, 
of unequal size, throughout its course; and when the subjacent 
parts are exposed by the removal of the skin which before co- 
vered them, the muscles are as completely denuded of all their 
cellular covering, as if they had been most carefully dissected. 

956. Should the part attacked in this way be a depending 
one, the ill-formed pus, or sanies, insinuates itself to an uncer- 
tain extent; for it has no bounds set to its ravages, by a pro- 
tecting effusion of coagulable lymph, as in a genuine phlegmonic 
inflammation. Hence, we once saw it run from the lower point 
of the left scapula to the base of the sacrum. 

957. Notwithstanding the apparent irregularity of this species 
of inflammation, it has four distinct stages: 1st, inflammation 
without vesications; 2dly, with vesications; 3dly, with vesica- 
tions and suppurations; 4thly, gangrene. There is something 
very peculiar, if not sui generis, in this inflammation; and on 
this peculiarity does its danger very much depend; but our limits 

1 1 have had a case lately in which this affection, the third day after delivery, 
attacked the whole of the upper portion of the back — that is, from the occipital 
bone to a little below the points of the scapula. There was much hardness, red- 
ness, and swelling of this part — it was relieved by the mercurial ointment alto- 
gether; no other application having been made. It required four weeks to con- 
firm the cure. 

a Jt seems very certain that this disease is both idiopathic and symptomatic — 
therefore, fever may follow the appearance of this inflammation, or this inflam- 
mation may be subservient to fever. 



OF ERYSIPELAS. 259 

do not permit us to describe them but in very general terms. 
1. Its erratic disposition — as it may in an instant almost leave 
the part it occupied to seize upon another, however remote or 
important that part may be. 2. Its disposition to vesicate. 8. 
The rapidity with which it runs on to its own peculiar suppura- 
tion ; for it is without any provision, by the effusion of coagu- 
lating lymph, to limit its extent. 4. To its strong tendency to 
gangrene, seeming at once to kill the skin and cellular membrane, 
by the force of its previous inflammation. 

958. Much difficulty has ever been experienced in the manage- 
ment of this disease, especially in children, with whom its pro- 
gress is almost always more rapid and subduing than with adults ; 
and not less diversity of opinion than difficulty has existed, as 
to the proper plan to be pursued. In almost every part of Eu- 
rope this disease is considered one of great danger ; and, in this 
country, it has had but too many victims. Whether this disease 
be necessarily one of so much danger, is much to be doubted, 
unless difference of climate has more influence than the mode of 
treatment; for it has certainly, within the last few years, been 
less fatal than formerly, and this melioration, we believe, is justly 
attributable to the plan of cure. 

959. Dr. Underwood thinks the bark the best constitutional 
remedy, and saturnine and camphorated applications to be the 
best local remedies. Mr. Burns approves of cold watery appli- 
cations, where the heat of the part is considerable, but thinks, 
with Dr. Gartshore, that the camphorated spirit of wine is the 
best application from first to last. He seems doubtful as to the 
efficacy of the bark, but recommends from five to ten grains of 
ammonia, 1 every three hours — but says he has derived more 
benefit from calomel purges than from any other medicine. 

960. We shall say a few words upon each of these plans, be- 
fore we detail the one usually pursued by ourselves and other 
practitioners in this city. 1. As the system evidently labours 
under high arterial action in the commencement of almost everv 
case of erysipelas that requires medical treatment, the bark must 
not be thought of, either in the first or second stages of the dis- 
ease : in either of the last two it may often be proper, if the 
suppuration or sloughing be extensive. 2. As regards the topi- 
cal applications recommended by these gentlemen, the cold satur- 
nine have always appeared to us, if not of hurtful tendency, at 
least of doubtful efficacy. In the early or first stage of erysipe- 
las, the camphorated spirit we have thought occasionally useful, 
but never efficacious. 3. The propriety of using ammonia in 
such immense doses to a child, perhaps within a month old, is 

1 We take it for granted that Mr. Burns means the carbonate of ammonia, by 
the simple word ammonia. 



260 OF ERYSIPELAS. 

extremely doubtful, even if it were possible to give it, (which, 
by the by, in our opinion, is extremely problematical;) but its 
usefulness in any quantity may be justly doubted, especially as 
the disease, in its commencement, at least, according to Mr. 
Burns himself, is attended with fever. Of the good effects of 
calomel purges we entertain no doubt; but must say purging 
with it, or any other cathartic medicine, seems to be much at 
variance with bark and volatile alkali. 

961. It is probable that erysipelas may have a number of 
counter-agents; but there are very few, we believe, yet ascer- 
tained. In the time of Ambrose Pare blisters were employed to 
interrupt the progress of this inflammation, both as regards the 
extent of surface over which it might be supposed to travel, as 
well as the termination of two of its stages in either suppuration 
or gaDgrene. This remedy, however, was either forgotten or 
laid aside, for nearly two centuries, because the modus operandi 
of the application could not be explained. To the late Dr. Phy- 
sick we owe its revival, the importance of which can only be ap- 
preciated by those who have witnessed the almost wonder-work- 
ing operation of this agent. We have frequently succeeded with 
it, both in the adult and in the child ; and can most safely re- 
commend its application, when the inflammation attacks such 
parts as can readily be covered with a blister. 

962. The plaster should be of such a size as will rest with 
certainty upon the sound skin — if this precaution be not taken, 
its application will avail but little. When the sound skin is well 
vesicated, the plaster is to be removed, and the part to be treated 
as if a blister had been used for any other purpose. 

963. It, however, frequently happens, that a blister will be in- 
expedient, from the peculiar location of the disease; in such 
case, we use the strong mercurial ointment, (with turpentine,) 
by covering the inflamed as well as the sound skin, with a coat 
of it ; and when it is removed, or become dry, it is renewed by 
a fresh application. We use this ointment differently, however, 
in the several stages of this inflammation : we shall, therefore, 
describe our method ; and, 

964. 1. Where the part is inflamed, but not yet vesicated. 
When we see the inflammation in this stage, we cause the whole 
of the reddened part, as well as a portion of the sound skin, to 
be covered with the ointment; which is to be renewed when the 
part is deprived of any portion of it. 

965. 2. Where the part is vesicated, but the vesicles not 
opened. In this case, we cause the vesicles to be carefully 
opened, and the ointment applied as just directed for the first 
condition. 

966. 3. Where the vesicles have opened spontaneously, and 
the part has become incrusted, and the inflammation spread to 



OF ERYSIPELAS. 261 

a considerable, or to a more limited extent. In this case, we 
direct the ointment to be applied only to the surrounding in- 
flamed margin, and on a portion of the sound skin. 

967. 4. Where portions have proceeded to suppurate, yet a 
part of the surrounding skin is inflamed. Under such circum- 
stances, we open the collections of matter as early as possible ; 
and apply the ointment to the margin, as above directed. (966.) 

968. Such is the efficacy of the mercurial application, that it 
almost immediately arrests the farther progress of the disease ; 
therefore, when practicable, it should be had recourse to early. 

969. We know but one objection to this powerful counter- 
agent — the patient sometimes becomes salivated. This, how- 
ever, seldom or never happens with young children, who are most 
obnoxious to the disease for which it is prescribed. In adults, 
on this account, we sometimes prefer the blister. 1 

970. We have already noticed that the suppuration in the 
erysipelatous inflammation is not of a genuine pus; it is always 
more or less bloody, and generally very offensive — this may also 
be said when the part becomes gangrenous. The charcoal poul- 
tice, in such cases, is of great value ; or the diluted pyroligneous 
acid may be most advantageously used ; or a poultice made of a 
strong decoction of bark, or even of its substance. 

971. Hitherto we have dwelt upon the external treatment of 
erysipelas ; we shall now speak of the internal remedies which 
we have found best suited to this disease. 

972. In the early stages of this affection, when accompanied 
by constitutional symptoms, as fever, headache, delirium, &c, 
the patient should be confined exclusively to the mother's milk, 
and that given but seldom. The bowels should be kept freely 
open, but not severely purged, by small but repeated doses of 
calomel. Should fever run high, with strongly-marked cerebral 
affection, the child should lose blood from the arm ; or from the 
temples, by leeches. 

973. Fresh, cool air should be admitted to the body of the 
patient ; and the room should always be well ventilated. Among 
many people there is a prejudice against this plan; they are- 

1 It would seem that the origin of the mercurial treatment is peculiar (o this 
country; and the honour of the discovery is claimed by Drs. Little and Dean. 
Their claims are urged with such equality that there would be risk of doing in- 
justice to one by admitting the claims of the other. 

It appears that this is not the only mercurial preparation that has been useful 
in this complaint. A solution of the corrosive sublimate, in the proportion of 
one grain to the ounce of water, Dr. Schott of this city informs us, has been found 
equally efficacious. And it may justly be questioned whether this practice may 
not be of old date, but, like many other substances, fallen into disuse, from occa- 
sional failures; certain it is, we saw it used very extensively about the year 1785 
or '6, in an erysipelatous condition of the leg from phlegmasia dolens. The pre- 
cise effect of this application is not at this time recollected, as it was supposed at 
the time by me to be a part of the routine of practice in such cases. 



262 OF ERYSIPELAS. 

fearful of adopting it, lest the inflammation "strike in." But 
of this, they should be assured there is no danger; and the plan 
must be insisted on. 

974. When this inflammation runs on to suppuration, or ter- 
minates in gangrene, the system will become enfeebled, either 
by the extent of the discharge, or the peculiar character of the 
disease; especially when it has a tendency to become epidemic. 
Here we are persuaded that bark, in some form or other, becomes 
absolutely necessary ; and, as far as one case will justify the 
recommendation, in the form of a sulphate, is the most easy of 
exhibition, and is as efficacious as in substance or in decoction. 
The bowels at this time are very apt to become too loose — this 
must not be permitted to go on, or the little sufferer will speedily 
sink. 

975. To arrest the too free motion of the bowels, the chalk 
mixture, with minute doses of laudanum, should be given in the 
following form : — 

R. Creta ppt. ^ij. 

Tinct. Thebaic. gut. x. 

01. Carui. gut. j. 

Sacch. alb. gij. 

Aq. font. giss. M. 

Of this a child of ten days old may take half a tea-spoonful 
every two hours, until better; one of a month, to that of two 
months, a tea-spoonful, as often, until the bowels are checked. 
Should it appear to be in pain, an additional quantity of lauda- 
num must be given ; say from one to two drops. 

976. The child may now be indulged with the breast, to the 
extent of its appetite ; and its little strength must be husbanded 
with every possible care. It may, with this view, from time to 
time, take two or three tea-spoonfuls of wine whey, carefully 
made, and not of too great strength. 

977. The whey should be made as follows: take half a pint 
of new milk, and bring it to the boiling point, in an earthen or 
silver vessel — at that moment throw into it a common-sized wine- 
glassful of Madeira, Sherry, or good Teneriffe wine — stir it two 
or three times round, and then set it in a cool place to sepa- 
rate. When separated, pour off the whey from the curd, and 
sweeten it to the taste with loaf sugar. 

978. Of that form of erysipelas, which attacks the genital 
parts of new-born children, we have seen but one instance ; and 
this, not until nearly the whole of the parts were destroyed, and 
when art could do nothing for its relief. 



OF THE RETENTION OF URINE. 263 



CHAPTER VI. 

OF THE RETENTION OF URINE. 

.979. It very frequently happens with newly born children 
that they do not pass their urine for many hours after birth, or 
so sparingly as to afford little or no relief. This creates a great 
deal of distress, and, if not relieved by proper means, will some- 
times occasion death. A very remarkable instance of this kind 
fell under the notice of my friend Dr. Parrish, and myself, which 

given in detail, we trust, will require no apology. Mrs. was 

delivered of a healthy child, on the 15th of June, 1822. On 
the 20th, in the evening, the child showed uneasiness; and on 
the 21st, it cried violently, and continued to be much pained 
until the 25th. A variety of simple remedies were used for the 
relief of the urine, which had been either very sparingly passed 
or entirely suppressed, most probably from the 20th — but with- 
out relief. 

On the morning of the 25th, at ten o'clock, we found the 
abdomen very much distended, even to the scrobiculus cordis ; 
the skin was shining, and the superficial veins were very much 
enlarged. The child had several very sparing stools of a dark 
green colour: two spoonsful of castor oil were given in the course 
of the morning. At half past one o'clock, P. M., Dr. Parrish 
introduced a small flexible catheter, and drew off at one time 
eighteen ounces and a-half of the straw-coloured urine. 1 At 
seven o'clock the same day, the child appeared perfectly relieved ; 
it slept soundly, and took nourishment freely. Two more tea- 
spoonsful of castor oil had been given since the visit at noon, 
but without moving the bowels ; nor did any water pass. As 
the child was easy, it was permitted to rest without disturbance. 

980. From this time, the water was regularly drawn off by 
the catheter until the child's death, which happened on the 28th. 

1 "The introduction of the catheter, spoken of in the case of a child of ten days 
old. We have never had occasion to employ the instrument at so early an age, 
and fear that its employment is more easily described on paper than carried into 
execution in practice, particularly in the male." — Lond. Med. and Phys. Journ. 
August, p. 149. 

In a case similar to the one which gave rise to the above observation, it may 
be asked, what other resource does our art afford? I have not declared, nor even 
insinuated, that the catheter should be used upon slight occasions, but where the 
retention is confirmed, and where every usual expedient was resorted to, and had 
failed, should we suffer the patient to die, because the introduction of a catheter 
is considered difficult? I can truly say, in the above case, the gentleman who 
performed the operation found no difficulty whatever. 

In relating the above case, I have confined myself to the detail of the main 
facts, I have not attempted to describe the mode of introducing the catheter. 



264 OF THE RETENTION OF URINE. 

It had gradually declined from the time of our first visit, and its 
mouth had become very sore. Permission was not obtained to 
examine it. 

981. We have recorded this case on account of its great prac- 
tical importance, though unfortunate in its issue. We have seen 
several instances similar in their general appearance to the one 
just related, and, like it, ending in death : we have strong reason 
to believe they may have died of retention of urine, though we 
were assured that they had passed water — the same was insisted 
on, for awhile, in the case just mentioned, and, perhaps, there 
may have been a small discharge, as always happens when the 
bladder becomes excessively distended. We know that this often 
takes place in the adult, from the same cause. We ever make 
it a rule to inquire into the state of the bladder, in all the little 
complaints of very young children ; but we fear we have been too 
easily satisfied with the reports of the nurse upon this subject — 
we now make it our business, whenever we have any suspicion 
that the urine is not freely evacuated, to examine the abdomen 
of the child, especially if it be reported as swelled — we care- 
fully examine the region of the bladder, with a view to detect 
any distention of it, if it exist, that we may take our measures 
accordingly. We are sincerely of opinion, that, had the ca- 
theter been introduced twenty-four hours sooner, nay, perhaps, 
twelve, the poor infant, whose case is related above, might in 
all probability have been saved; but, as there was a constant 
assurance that water passed, no suspicion was entertained of 
the state of the bladder, until all the mischief was done that 
could well happen from its fulness. We always inquire into the 
state of the bladder, and did so particularly in this case, and 
were constantly assured by the nurse that water had been freely 
passed. 

982. We suggest, as a matter of probability, that the cases 
we have witnessed of death in very young children, where the 
abdomen has been much swollen, and the superficial veins 
passing over it much distended, and very conspicuous, were 
similar affections of the bladder, though no such suspicion was 
entertained at the time. How far a distended belly, (indeed, 
almost to transparency,) with greatly enlarged veins, may serve 
to distinguish this state of the urinary organs in very young 
children, must be left to future observation. We have felt it a 
duty to express this impression, with a hope that it may awaken 
attention to those whose province it is to witness numerous cases 
of sickness, especially in very young children. The case just 
related is an extreme one : many occur where the retention is 
not so absolute, yet it is every way important to offer some re- 
lief to the bladder. For the most part, these slight retentions 
are easily removed by a few drops of the sweet spirit of nitre, 



OF APHTHiE. 265 

once an hour, in a little sweetened water; or, if obstinate, it may 
be aided by the warm bath and a tea-spoonful of castor oil. A 
little parsley root tea, also, succeeds remarkably well. 



CHAPTER VII. 



OF APHTHA. 



983. This complaint is generally called the baby's sore mouth : 
it consists of a greater or less number of white vesicles on the 
inside of the mouth. It very generally begins on the inner part 
of the lower lip, or corners of the mouth, and much resembles a 
small coagulum of milk. From this point, it sometimes spreads 
itself very rapidly over the inside of the cheeks, tongue, and 
gums ; and, at others, it will appear in the same form, and at the 
same time, on several portions of the mouth; as inner portions 
of the cheeks, &c. The French, especially Mr. Billard, make 
it a different disease from what they term "Muguet." But from 
a careful examination of the two diseases, I believe them to be 
the same, differing only in intensity. I think we have not the 
disease which he terms "Muguet," or I do not understand his 
description: as far as I have been able to compare them, they 
are identical. The difference may consist in the modification 
which a hospital may give it: if there be a difference, I think it 
must be owing to this cause. When this efflorescence is exten- 
sive, the child slavers very much, and is frequently embarrassed 
in its sucking ; it cries, and evidently betrays that it is in pain ; 
it is very restless and very thirsty, as it evinces by its frequent 
stirrings, and its disposition to be continued at the breast. The 
eruption in its mildest form is very white, and looks as if a stra- 
tum of milky coagulum were spread over the mouth. It some- 
times confines itself to the centre of the cheeks, at others to the 
lower lip, or one side of the tongue. In its severer forms the 
appearance of the eruption is of a dark-brownish colour, or ex- 
tremely red; owing, most probably, to minute portions of blood; 
but both are evidently grades of the same affection, changed 
either by mismanagement, constitution, or the force of the re- 
mote cause. 

984. This affection is thought to be altogether of a sympto- 
matic kind — or very rarely idiopathic. It is almost uniformly 
preceded by a deranged condition of the stomach and alimentary 
canal, and always, we believe, by some disturbances of the sto- 
mach itself. The brain always shows signs of participating in 



266 or aphtha. 

this complaint, as there is almost always an unusual inclination 
to sleep, though the child is frequently disturbed in its nap by 
some internal irritation, perhaps of the bowels themselves.* This 
disposition to sleep is so well known to nurses that they will 
frequently tell you " the child is sleeping for a sore mouth." 
The bowels are often teased by watery, acrid stools, of a greenish 
colour; their discharge is frequently attended with the eruption 
of much wind, and, to judge from the noise, it would be supposed 
there was a very large discharge of faeces, though, upon exami- 
nation, it is found to be very sparing. 

985. The alvine discharges are frequently very acrid, so much 
so, sometimes, as to excoriate the verge of the anus and nates 
very severely ; especially when due attention is not paid to clean- 
liness, or to the frequent changing of the diapers. But this 
never takes place until the disease is pretty well advanced, and 
has made some progress ; it is generally pretty well spread over 
the mouth, and always shows a violent disease. The stomach is 
also sometimes much deranged; vomiting the milk very soon 
after it is received into the stomach, in the form of a dense curd, 
mixed with a porraceous mucous substance. If the milk be not 
voided by vomiting, the stomach constantly discharges, by eruc- 
tations, a gas with a very sour smell. The child, when the dis- 
ease is severe, soon becomes debilitated, and rapidly emaciates; 
it is almost constantly harassed by severe colics, and profuse 
diarrhoea ; its stomach will scarcely retain the little it can swal- 
low; and the oesophagus sometimes becomes so loaded with aph- 
thae, that it can no longer transmit the small quantity which is 
reluctantly admitted into the mouth ; and the child dies, either 
from the exhaustion consequent upon the profuseness of the dis- 
charges from its bowels, or from inanition. 

986. It is a popular belief that this aphthous efflorescence 
passes from the mouth through the whole tract of the alimen- 
tary canal, to the very termination of the rectum ; and the ex- 
coriation at this part is offered as evidence of the fact. Whe- 
ther this be true or not we do not know, for we are not in 
possession of any facts from dissection which decide the point. 
We once examined a body wdiich certainly died from aphthae, the 
examination of which would by no means tend to confirm this 
common belief. A child, on the tenth day after birth, was ob- 
served to have a number of white spots upon several different 
portions of its mouth, which rapidly spread over its whole sur- 
face. It had the usual premonitory and accompanying symp- 
toms, which increased daily in severity, in spite of every effort 
to oppose them. It was a feeble, weakly child, of a consump- 
tive, feeble mother. Its sufferings were very great, though un- 
der some control from laudanum, so long as it could be taken by 
the mouth, or retained by injections — coat after coat of aphthae 



OF APHTHA. 267 

were thrown off, and each new crop appeared to he more abun- 
dant, and less amenable to remedies, until, at last, at the end 
of two weeks of severe suffering, the poor infant could not swal- 
low a drop of the thinnest fluid. Injections of bark and mut- 
ton tea, in conformity with popular opinion, were resorted to, 
but all in vain ; the child, in a few days more, died from abso- 
lute starvation, or, at least, the catastrophe was certainly hur- 
ried by the impossibility of receiving nourishment. 

987. We examined the body after death — we found the whole 
tract of the oesophagus literally blocked up with an aphthous 
incrustation, to the cardia, and there it suddenly stopped. The 
inner coat of the stomach bore some marks of inflammation, as 
did several portions of the intestines; but not a trace of aphthae 
could be discovered below the place just mentioned. This case 
would, therefore, create a doubt, whether this affection besieges 
any other parts of the body than those just stated, namely, the 
mouth, posterior fauces, and the oesophagus to the cardia, since, 
perhaps, none could have been of greater severity; but it is with 
us a solitary case, and should not be received for too much. Dr. 
Heberden says, "The aphthae are supposed not only to infest 
the mouth and fauces, but to be continued down through the 
whole intestinal canal. In two who died of lingering fever, and 
whose mouths were covered with aphthae, which hung in rags all 
over it, there was not the least trace of them that could be found 
in dissection beyond the fauces." 12 The excoriations about the 
anus can certainly be accounted for, without the presence of 
aphthae to produce them : in bad cases the stools are always ex- 
tremely acrid, and the parts over which they constantly pass 
and spread are, at such a tender age, very delicate, and very 
readily excited to inflammation. 

988. Dr. Good seems to admit, without hesitation, the trans- 
mission of aphthae through the intestinal canal; for he says, 
without reserve, "The fauces become next affected, and it de- 
scends thence through the oesophagus into the stomach, and tra- 
vels in a continuous line through the entire course of the intes- 
tines to the rectum, the faeces being often loaded with aphthous 
sloughs." 3 

989. We are afraid there is too much taken for granted in 
this account; we know of no decided evidence of the fact, nor 
does Dr. Good name any authority for the statement. The case 
alluded to was certainly one of death from aphthae; but, in it 
the aphthous efflorescence stopped at the cardia. Is it probable 

1 Commentaries, p. 31. 

9 " It is well known too, that in small-pox, no pustules are traced beyond the 
pharynx and larynx, even in the most severe cases, when the mouth and tongue 
are thickly covered with the eruption." — Tweedie's Illustrations, p. 65. 

3 Study of Medicine, Vol. II. p. 391. 



268 OF APHTHA. 

that any child could survive this affection, did it travel the whole 
course of the intestinal canal? We think not — yet aphthae is 
rarely a dangerous disease in infancy. Dr. Good's description 
of this affection would certainly lead to the conclusion that it is 
the ordinary march of the disease to pass through the bowels, 
and manifest itself at the verge of the anus. This point is far 
from being settled in the minds of pathologists : even the French 
are far from having ascertained it with certainty — it is true Mr. 
Billard says he has seen evidences of it in the large and small 
intestines, as well as the stomach; but there is no mention of it 
lower than the ilium. 

990. Now this cannot be so ; since it is in violent and long- 
protracted cases, alone, that the anus discovers any signs of ir- 
ritation from this cause, which would not be the case, were Dr. 
Good's account correct. 

991. Dr. Good and others suppose that aphthae communicates 
itself by a specific contagion; 1 and give as evidence, the exco- 
riations of the nurse's nipples. We do not hesitate to believe 
there is a discharge from these little pustules which may be 
highly acrimonious to the denuded skin, but we think this is 
perfectly innoxious to a sound one. For we have never seen 
sore nipples produced by aphthae, where the skin of these organs 
was perfectly sound. That they aggravate the tenderness and 
inflammation, when these parts are tender and abraded, we 
admit, and so would any other acrid substance, without having 
recourse to the belief of a specific contagion. If this were the 
case, why do not the lips of children labouring under this af- 
fection, betray its influence? 

992. That this complaint is occasionally epidemic, there is 
every reason to believe; and this circumstance, among some 
others to be mentioned, renders the opinion so commonly credited 
(of its being a sympathetic affection,) very questionable. We 
have always considered aphthae as arising from some peculiar 
condition of the stomach; but, from some late cases, and more 
mature reflection, w r e think it may be otherwise. Our reasons 
for doubt are, 

993. 1. We have recently seen this affection in two cases 
where the stomach and bowels were in the most perfect order 
before the eruption ; but became disturbed a little during the 
progress of the disease. 

994. 2. That this complaint has been very often removed by 
topical applications alone, where the efflorescence has been very 
considerable, and where there was no remedy of any kind ad- 
dressed to the stomach and bowels. 

995. 3. That we do not uniformly see this complaint where 

1 Mr. Billard declares it not to be contagious. 



OF APHTHA. 269 

there has existed great disorder of both stomach and bowels, and 
these of a permanent kind. 

996. 4. That, however the stomach and bowels may be dis- 
turbed by acidity or other inconvenience; or, however long these 
may continue, if the child have had this complaint, it is not re- 
newed, though the individual is not exempt from a second attack, 
like measles, or small-pox: for. in certain chronic affections, they 
may be again visited by aphthae. 

997. 5. That this affection is sometimes epidemic, as stated 
above; for Dr. Good informs us that not only all the children 
of the same family, however cautiously separated from one an- 
other, but many of those of the same neighbourhood, have been 
known, at times, to suffer from it simultaneously. (Vol. II., p. 
391.) 

998. 6. That this disease is almost always ushered in by some 
cerebral affection, as great drowsiness or watchfulness : — the 
first is by far the most common. 

999. 7. That other portions of mucous membranes are liable 
to the same kind of eruption, without the condition of stomach 
or bowels being instrumental in its production ; for we have seen 
it most plentiful within the labia pudendi, as well as on the in- 
ternal face of the prepuce. 

1000. These facts have made us lately question the sympa- 
thetic origin of aphthae; yet we admit they are not altogether 
conclusive in our own mind ; but we thought it proper to suggest 
the possibility of its being an idiopathic disease of the mucous 
membrane. 

1001. This affection is not confined to early infancy; it shows 
itself in the more advanced periods of childhood; and from that 
to any period of human life. It is sure to attend the last stages 
of almost every long-protracted disease, especially those which 
may have wasting discharges ; such as phthisis pulmonalis, dysen- 
tery, or diarrhoea; and when it does appear, it is almost sure to 
be a fatal harbinger. 

1002. This disease is not essentially accompanied with fever ; 
if it accompany any chance affection, which is attended with 
fever, we do not find it to heighten the existing one. 

1003. Weakly children, and especially those born before their 
full period, are more obnoxious to this complaint than the robust 
and those who have tarried to their full time in the uterus — the 
children of weakly women, and particularly those who make bad 
nurses from scarcity of milk, or from its not being of a suffi- 
ciently nutritious quality, are more disposed to this affection than 
the children of hale women, who have plenty of nourishment of 
good quality. The children fed much upon farinaceous sub- 
stances, (535, 536,) are especially exposed to the attack of this 
disease, particularly when their food is sweetened with brown 
sugar or molasses. 



270 OF APHTHiE. 

1004. The treatment of this disease must always be commenced 
by a regard to the stomach and bowels : there is, we believe, a 
superabundance of acid, which should be destroyed by the use of 
absorbents. If there be no diarrhoea present, we are almost 
certain of finding whatever evacuations there may be of a green 
colour; and when this is the case, small doses of magnesia should 
be given until the bowels are purged; and this may be repeated 
pro re nata. Should, however, the bowels be urged to frequent 
dejections of a sparing, watery kind, and especially if attended 
with pain or straining, the following formula we have long adopt- 
ed with entire success : — 



R. Magnes. Alb. Ust. 


gr. xi]. 


Tinct. Thebaic. 


gtt. iij. 


Sacch. Alb. 


q. s. 


Aq. Font. 


gj. M. 



Of this a tea-spoonful is to be given every two hours, until* the 
bowels are more tranquil. Or, if green stools be frequently 
evacuated, we may substitute a drachm of prepared chalk for 
the magnesia; or, if there be no fear of the diarrhoea weakening 
too much, a scruple of the prepared chalk may be added to the 
twelve grains of the magnesia: by this combination we insure 
the destruction of the acid, and prevent the lax from being too 
soon checked. We have found, very often, great advantage 
from equal parts of lime water and milk, where green stools con- 
tinued; but without diarrhoea — a tea-spoonful of this mixture 
may be given four or five times a day. 

1005. When the disease has proved obstinate, and the bowels 
are much irritated by frequent, small discharges, and especially 
if there be any streaks of blood, we have found the most decided 
advantage from a tea-spoonful of the oil of butter given three 
or four times a day. The oil of butter is prepared by putting a 
lump of perfectly sweet butter into a tea-cup, and pouring on it 
a quantity of boiling water, and agitating it well with a tea- 
spoon, that it maybe deprived of its salt — the oil is then skimmed 
off as it is wanted; should it not be sufficiently fluid, pour off the 
cold water each time, and add fresh warm water. The gum 
Arabic water, made of an ounce of the gum and a pint of water, 
is a most valuable remedy. 

1006. During the continuance of this complaint, the child, 
when practicable, should be confined to its mother's milk, if this 
be of a healthy quality ; otherwise the sooner a fresh breast is 
acquired the better ; and the mother, or nurse, should at this 
time avoid such diet as would become acescent on the stomach. 
Most of the common vegetables should be avoided, though she 
may indulge freely in boiled rice with her meats at dinner: she 
should abstain from all kinds of liquors, especially the ferment- 
ed. She may drink freely of rice water, toast water, or milk 
and water. 



OF APHTHA. 271 

1007. We have constantly found in this complaint that local 
applications, when properly managed, are of the utmost conse- 
quence; we, therefore, direct their immediate use. 1 The best 
we ever tried is, certainly, equal parts of borax, (borate of soda,) 
and loaf sugar, rubbed together until very fine ; a small quantity 
of this in its dry state is to be thrown into the mouth, and re- 
peated every two or three hours. This mixture is quickly dis- 
solved by the saliva of the child, and is soon carried over the 
whole of the fauces. We should be very positive in forbidding 
the mouth of the child to be rubbed with any thing whatever, 
under the pretence of cleansing it. The cruel and mischievous 
practice of scouring the mouth with a piece of flannel, cannot 
be too strongly reprobated. We have seen a poor little creature 
in agony, after it had undergone this rude discipline from the 
heavy hand of an unmerciful nurse ; nay, we have seen it bleed, 
even freely, from the barbarous treatment it received under the 
specious pretence of doing it good. We are persuaded, from 
many years' experience, that the mouth requires no other wash- 
ing or cleansing than what may be procured from the appli- 
cation of the borax, and the frequent draughts of the mother's 
milk. 

1008. We do not, however, continue the borax, should the 
efflorescence become discoloured; we then generally employ the 
Armenian bole in fine powder with loaf sugar, and use it as we 
have directed for the borax ; but should this fail to give pretty 
speedy relief, and particularly if the mouth be very red, livid, 
or ulcerated, we have recourse to a weak decoction of the bark. 
We order half an ounce of powdered bark to be stewed in half 
a pint of water for twenty or five and twenty minutes over a 
slow fire, and then permit it to settle; about the third of a tea- 
spoonful of this is put into the child's mouth, every hour or two 
— as it is not agreeable to the child, it will not be much disposed 
to swallow it; by which means it will be diffused over the whole 
mouth — we have often seen this attended with the most marked 
advantage. 

1009. During the continuance of this complaint, the most 
scrupulous attention should be paid to cleanliness — the child's 
nates should be washed with flaxseed tea after every evacua- 
tion ; and the excoriated parts should be constantly defended 
by a coat of fine hog's lard, or the best quality of soft poma- 
tum. The same diaper should not be used twice without wash- 
ing. 

1 Dr. Underwood differs with us upon this head, though we have no hesitation 
to say that general experience is much in our favour. He says, "In regard to 
applications to the part, it is necessary to observe, as they have little to do in 
curing of the complaint, it will be improper to have recourse to them very early." 
Yet, a little farther on, he confesses that he has "met with an instance of a very 
copious thrush disappearing after clearing the mouth with borax and honey, at 
noon and at night, on the fourth day of the disease." 



272 op colic. 



CHAPTER VIII. 



OF COLIC. 



1010. Owing to improper feeding, or the peculiar quality of 
the mother's milk, or, perhaps, in some instances, to the particu- 
lar constitution of the child, it becomes liable to severe attacks 
of pain in the bowels, which continue for several hours, with 
great suffering to the poor infant. These colics are of two kinds 
— 1st, those which attack the child at any time of day, without 
evident cause ; and, 2dly, those that observe a periodical move- 
ment. 

1011. In the first, the child may be seized at any time of the 
day without our being able to trace the cause to any evident 
source. This kind generally attacks children of feeble consti- 
tutions, and, though the mother may have plenty of milk, and 
the child may suck it very freely, yet it does not thrive ; or it 
may attack children situated the very reverse of the one just de- 
scribed — here the child has not sufficient nourishment from the 
mother, or it is of bad quality: to supply the first defect, the 
stomach is overloaded with crude or improper diet, which not 
only fails to afford it a healthy nourishment but quickly turns 
acid, to the decided injury of the child. Perhaps diarrhoea, with 
green stools, is produced ; or it may not have too many evacua- 
tions, but they are evidently the remains of ill-digested food. 
When pain arises from the use of improper food, the child almost 
always becomes uneasy as soon as it swallows it; and if it arise 
from ill-elaborated milk, it complains as soon as it is done suck- 
ing. Its little abdomen becomes swollen and tense, and it writhes 
its body as if in the utmost agony. It sometimes becomes sud- 
denly relieved, by eructating a considerable quantity of wind; 
or it passes downwards, carrying with it a very small portion of 
faeces. 

1012. It is obvious that we must change the diet of the child, 
or alter the mother's milk, if we expect to relieve this complaint. 
We have already said enough on the subject of diet for young 
children, and need not repeat it here. When we are satisfied 
it is from the quality of the food that this complaint proceeds, 
it would always be advisable, if it were always practicable, to 
confine the child altogether to the milk of the mother; to de- 
stroy acidity by small doses of magnesia, especially if there be 
costiveness, as is sometimes the case. A small tea-spoonful of 
warm sweet oil, three or four times a day, is a remedy very often 
of great value. Should it depend upon the mother's milk, an 



of colic. 273 

attempt should be made to alter its quality by an almost total 
change of diet, and well regulated exercise. If this do not suc- 
ceed, we are obliged to have recourse to temporary remedies, 
rather than witness hourly the sufferings of the afflicted infant. 
This complaint most frequently commences in the month, but 
when it may cease it would be difficult to say. 

1013. We have sometimes been so fortunate as to succeed 
completely in curing this complaint, by the plan just suggested ; 
but it requires the strictest attention to attain success, and this 
continued for some time most perseveringly. Care should be 
taken that the child do not remain wet for a long time after its 
evacuations, from an unfounded opinion that it makes them hardy 
to use them to cold. By this management, the feet and legs 
become chilled; and the bowels, in consequence, are made to 
suffer a double portion of torture. During, however, the trial 
of changing the food, we must temporize, and administer imme- 
diate relief to the sufferer; for this purpose, we have been in the 
habit of employing the following mixture, with the most decided 
advantage ; it rarely failing to give instant relief, and sometimes 
effecting an entire cure: — 

R. Magnes. Alb. Ust. £j. 

Tinct. FoBtid. gut. lx. 

Theb. gut. xx. 

Aq. Font. |j. M. 

Of this twenty drops are to be given in a little sweetened water, 
when the child is in pain; and, if not relieved in half an hour, 
ten drops more are to be administered. This dose is calculated 
for a child from two weeks to a month old. If it be older, a few 
drops more must be given ; and as the child advances in age, or 
becomes accustomed to its use, the proportions of the ingredients 
must be a little increased. We must, however, caution against 
a too rapid increase of the dose, as this is by no means neces- 
sary; and it would be wantonly subjecting the child to the use 
of a medicine which should only be given when pain demands its 
exhibition. 

1014. The other form under which we are to consider this 
complaint is where it becomes distinctly periodical. It very 
often, however, commences with the erratic form, and after con- 
tinuing in this state for some time, it settles down to a certain 
period of the day : this is usually from four to six o'clock in the 
afternoon. Generally speaking, this form does not appear to be 
so injurious to the health -of the child as the other; indeed, it 
seems that the child even thrives with it, so that one might almost 
say, it is "cry, and be fat." Certain it is, that some of the fat- 
test and healthiest-looking children are troubled with it. We 
have never found the diet of either the mother or child to have 
much effect upon this form of the complaint, and in this it differs 

18 



274 of colic. 

materially from the first. It would seem to depend upon some 
constitutional peculiarity, over which we have but a temporary 
control; as it very frequently will stop of itself, as soon as the 
child reaches the age of three months : hence the old women say, 
the child has "the three months' belly-ache." 1 

1015. The child who is subject to this complaint is usually 
habitually costive ; but we have never, we think, derived any ad- 
vantage from the exhibition of purgative medicines : indeed, we 
think this in general to be a bad plan. When the constipation 
is more than usually protracted, we order a little opening medi- 
cine, of a mild kind, such as sweet oil, or the castor oil, syrup 
of rhubarb, or manna, as sweetening in the food, when the child 
feeds; or we direct an injection of molasses and water, or the 
introduction of a suppository of soap. 

1016. For the immediate relief of the child, we give it the 
mixture, as just prescribed, only observing it should be adminis- 
tered the instant the paroxysm is about to commence. Consider- 
ing this as a true periodical disease, we have given a decoction 
of the bark for it, with the happiest effect, in several instances ; 
but it has not always succeeded. 2 This complaint should excite 
but very little apprehension, as we believe it is never dangerous, 
and is almost sure to wear itself out after a certain period. 

1017. We will relate a curious instance of the influence of an 
aching tooth upon the secretion of milk, and its indirect agency 

in producing the "belly ache" of the first form. Mrs. was 

delivered of a fine healthy-looking boy, which appeared to do 
perfectly well for the first two weeks after birth. At this time 
it became uneasy, and frequently cried — the usual domestic re- 
medies were from time to time employed for its relief, without 
the smallest benefit. The complaint seemed to increase every 
day ; the pain became more severe, and longer continued ; the 
stomach and bowels were affected, the one with sour vomitings, 

'This disease must not be confounded with, or mistaken for, inflammation of 
the bowels, enteritis, or any other disease of the abdomen. We think the follow- 
ing marks will sufficiently distinguish it: the tone of voice, when the child cries, 
is a more acute sound; not so permanent, having intervals of shorter or longer 
continuance; the drawing up of the legs to relax the abdominal parietes ; the rub- 
bing with violence one leg against the other. The absence of all fever, the natu- 
ral feel of the skin ; pulse quiet, but more febrile, the bowels generally confined, 
and sometimes irregular, or green and watery; at other times very costive. 

a We have lately succeeded, in two instances, in arresting this distressing com- 
plaint by the use of the sulphate of quinine. The paroxysms occurred in the 
afternoon about four or five o'clock; and they would continue several hours with 
great violence. The following prescription was employed: — 

]J. Sulph. Quinine, gr. iss. 

Sacch. Alb. s;iss. 

Aq. Font. Jj. ft. sol. 

A tea-spoonful every hour, in the absence of pain. I am the more satisfied with 
this mode of treating " colic," as several of my friends tell me they have also 
succeeded with the same medicine exhibited in the same manner. 



OF OPHTHALMIA. 275 

the other by frequently discharging green stools. The child 
could obtain no relief but from laudanum, and this we were 
obliged to give in large and constantly increasing doses. The 
emaciation was so great" as to render the child lighter at three 
months old than when first born. In this situation did things 
continue, without much aggravation or amendment, until the 
child was five months old. By this time it was, (without a figure,) 
nothing but skin and bones. 

1018. At one of our visits we observed the mother apply her 
hand very suddenly to her face, and press it forcibly, as if in pain 
from a tooth — we inquired of her what she ailed ; she informed 
us she was very much tormented, both by day and by night, with 
toothache, and had been for some time before the child was born, 
and ever since. We immediately declared our opinion that this 
was the cause of the affliction of her child — the constant pain 
she was enduring, and the great loss of sleep, so affected her 
stomach, and indirectly the breasts, that they could not yield a 
healthy nourishment. We advised her to send immediately for 
a dentist, and have the tooth extracted. This was accordingly 
done ; and from that day the child began to recover, and in a 
short time was perfectly restored to health. 



CHAPTER IX. 



OF OPHTHALMIA 



1019. From about the fourth to the seventh or eighth day, 
or sometimes longer, after delivery, the eyes of the child are 
found to inflame; they are first observed to glue up in the morn- 
ing, and quickly after the whole of the lids become swelled, and 
especially in the early part of the day, or until the eyelids have 
become enclosed, and given issue to some purulent matter the 
eyes themselves are soon found to partake of the inflammation 
of the lids, and have a peculiarly fiery appearance : the child 
now keeps its eyes entirely closed, or closes them at the approach 
of even a weak light. After a plentiful secretion of pus has 
taken place, which generally happens after the third or fourth 
day, the lids during the night become pretty firmly attached to 
each other, in consequence of the discharge from them becoming 
inspissated, and thus gluing them firmly together : this permits 
a considerable accumulation of pus behind them, which distends 
the upper eyelids, especially, very considerably, and swells them 
sometimes even within the socket. Upon moistening the eyes 
with warm water, the lids are enabled to separate, which permits 



276 OF OPHTHALMIA. 

a considerable quantity of pus to discharge itself, — the eyes now 
seem to swim in pus, and the dark parts of them can no longer 
be seen. The whole of the internal lining of the eyes, which 
become exposed upon separating the lids, is of a bright scarlet 
red, manifesting an intense degree of inflammation, which, if 
not interrupted by very active remedies, runs on to disorganiza- 
tion and total blindness. 

1020. The remote cause of this complaint is some foreign 
matter they acquire in transitu — this may be the matter of 
gonorrhoea or leucorrhoea. 

1021. This disease may, therefore, with much propriety, be 
called "the purulent ophthalmia." It would seem that it could 
only arise, at the age at which appears, from the application of 
some foreign matter, as of leucorrhoea or gonorrhoea. We are 
firmly persuaded that one or other of these matters is the 
cause of the affection under consideration; and for the following 
reasons: — 

1022. 1. Because it always makes its appearance within ten 
or twelve days after birth — a period in which such a cause might 
be supposed to act. 

1023. 2. Because in every instance in which we have met with 
this affection, we have learnt, upon inquiry, that the mother was 
subject to leucorrhoea; and, in some few instances, in loose cha- 
racters, to gonorrhoea. 

1024. 3. The suddenness, extent, and severity of the inflam- 
mation, together with the profuseness of the suppuration, would 
seem to denote the application of some violent irritant to this 
tender and susceptible organ. 

1025. On this account, at the first washing, we direct the 
nurse, when we know or suspect this condition of the mother, to 
be very particular in applying plenty of water to the eyes. We 
have taught this doctrine of the remote causes of purulent oph- 
thalmia, for more than thirty years, and have recommended the 
plan of freely washing the eyes, for the same period; and we 
have reason to believe we have in some instances prevented it 
altogether, and in others have rendered it much lighter. In one 
case, where we knew gonorrhoea to be present in a violent de- 
gree, we prevented this affection almost altogether, by having 
the eyes washed very carefully with warm water for fifteen or 
twenty minutes, and pouring it upon the eyes in a full stream. 
The eyes suffered, however, a little; a slight inflammation su- 
pervened, but was relieved in two or three days by the mucilage 
of sassafras alone. We are of opinion, however, that the in- 
convenience the eyes suffered may be pretty justly attributed 
to the discipline they underwent in washing. 

1026. The mode of treatment is, perhaps, precisely the same 
in both instances — or, at least, we know of no substance that 



OF OPHTHALMIA. 277 

will more certainly control the inflammation of gonorrhoea than 
that arising from leucorrhoea ; unless, in desperate cases of the 
former, wc might apply some mercurial preparation — for in- 
stance, three or four grains of calomel suspended in an ounce 
of gum Arabic solution, and applied three or four times a clay, 
in addition to the remedies we shall presently mention. But 
this is altogether hypothetical. 

1027. Nothing can be more unsatisfactory than Dr. Under- 
wood's description of ophthalmia purulenta, nor any thing more 
vague than his plan of cure, if it even deserve that name. In- 
stead of ordering his remedies to the different stages of the 
complaint, and pointing out the time and the signs by which the 
time might be known at which it would be proper to change 
them, he confounds, under one general direction, opposite and 
incompatible remedies. 

1028. After vaguely describing the disease as just stated, he 
recommends, in one breath, purging, leeching, and blistering, 
to the back, neck, and behind the ears ; the last to be renewed 
every three or four days. " The edges of the eyelids should be 
greased throughout the day; at night, a lead-water poultice; but 
if the eye be affected by the weight of the poultice, it must be 
removed, for rags dipped in cold brandy and water, or some 
other more astringent lotion." He then adds, 

1029. " Throughout the complaint, astringent and stimulating 
applications are to be made use of, unless the complaint be un- 
usually slight, or sensibly give way very soon to mere greasing 
the lids, as it sometimes will." And then gravely declares, that 
" should emollient poultices, and merely cooling collyria be de- 
pended upon, the event were likely to be fatal." 

1030. I would ask any experienced practitioner if he could 
possibly attempt to cure this formidable inflammation by the 
directions just given? At one moment the eyes are to have 
blood extracted from them; then they are to have astringent 
and stimulating remedies applied to them : " For if you depend," 
says the Dr., " upon merely cooling collyria and emollient poul- 
tices, the event may be fatal." Yet he directed, just before, 
that the eyelids should be greased at night, " which will very 
often cure the disease alone." We are of opinion that no 
greater error can well be committed, than the too early use of 
astringent or stimulating collyria. We are persuaded we have 
seen several eyes destroyed by their ill-timed use. 

1031. Mr. Burns also_recommends, in the beginning of this 
disease, "some astringent solution;" than which, we feel it our 
duty to say, there cannot well be a more hurtful application. We 
have been called in consultation several times, where the plan 
of Dr. Underwood and Mr. Burns had been employed; and, 
from the state of the eyes when we first saw them, we are alto- 



278 OF OPHTHALMIA. 

gether convinced, that the stimulating or astringent collyrium 
had done irreparable mischief. We are, therefore, persuaded, 
they never can be successfully employed, but after considerable 
abatement of the inflammation. Even blisters, when used too 
early, are oftentimes mischievous, though highly important in 
the progress of the cure. 

1032. This case must be actively pursued by remedies, if any 
good is to be derived from them; there is no time to temporize; 
and the most vigilant attention must be paid to the eyes, or they 
quickly perish. We should commence our plan by leeching — 
about three common sized ones should be applied to each eye, 
or rather to the temples (if both be affected ;) the bleeding from 
the leeches should be encouraged for some time by the applica- 
tion of a soft bread and milk poultice, confined between the folds 
of fine linen. After the weeping from the leech wound ceases 
the eyes should be exposed to the air in a very dark room, and 
should be kept cool by a very weak solution of the acetate of 
lead in rose water, in the proportion of two grains of the former 
to an ounce of the latter. This is best employed by washing 
the surface of the eyes frequently, with a fine piece of linen rag, 
wet with the solution. The eyes should not be bandaged up, as 
heat does much mischief. Should the eyes betray a disposition 
to glue up, notwithstanding the frequent moistening, care should 
be taken to prevent it, by washing them carefully with the mu- 
cilage of the pith of sassafras, every hour or two. We should 
keep the bowels freely opened, or rather purged ; and for this 
purpose, we have found the following answer extremely well : — 

R. Calom. ppt. gr. iv. 

Magnes. Alb. Ust. gr. viij. 

M. div. in viij. 

One of these powders to be given morning and evening, mixed 
in a drop of any common syrup. Should this quantity not purge 
sufficiently, let another powder be given — should this operate 
too freely, give but one. 

1033. If the inflammation be not abated by these means in 
the course of forty-eight hours, the leeching should be repeated, 
and the other treatment recommended strictly followed. As 
soon as the violence of the inflammation is overcome, we should 
apply a blister to each temple, which should be encouraged to 
discharge by dressing with basilicon or weak savin ointment. 
Dr. James 1 says, that " blisters have occasionally been applied 
over the closed eyelids, with the best effect." We can say no- 
thing of this from our own practice, but it can be safely relied 
upon, coming from such authority. 

1034. Alter the disease is so much weakened as to permit the 

1 Burns' Midwifery, Vol. II. p. 32. Note. 



OF OPHTHALMIA. 279 

child to open its eyes in a dark room, we may safely begin to 
use some weak, mild collyrium with advantage: the best that 
has presented itself to us is a weak solution of the acetate of 
zinc, as follows: — 

R. Acetas Zinci. gr. ij. 

Aq. Rosar. ^ij. ft. sol. 

The eyes to be washed with this four or five times a day. 1 

1035. It is found to be very useful to wash the matter from 
the eyes by injecting warm soft water between the lids three or 
four times a day, by means of a small syringe. The mother's 
milk is also thought to be very useful in preventing the eyelids 
from sticking together, by being frequently milked upon them. 
The nitrate of silver has almost superseded the employment of 
any other application. Six grains to the ounce of water, and 
introduced into the eye by means of a quill, being cut at both 
ends, and one of the ends being placed in the solution, and while 
there, stopped so as to make it act as a capillary tube. This is 
to be conveyed to the eye, it being previously opened: upon 
removing the finger at the cut extremity of the quill, a drop 
will issue from the other extremity ; this to be dropped within 
the lids; the eye is then to be closed, and the child placed in a 
dark room. This may be repeated daily, or through the day, as 
the necessity seems to require. This remedy seems never to re- 
quire any auxiliary. 

1036. The child is sometimes afflicted with pain in the bowels, 
which occasions it to cry very much. This should be prevented 
by giving it a little mild anodyne of almost any kind ; half a 
drop to a drop of laudanum in a little sweetened water; or a 
little of Dalby's carminative from time to time, will be found a 
very good substitute for the laudanum, or the mixture prescribed 
above (1013) which will not produce constipation. 

1 The stage of the inflammation constitutes an essential point in the treatment 
of ophthalmia, and when this is lost sight of much mischief is oftentimes done. 
Thus, the experiments of Wilson, Philip, Hastings, Gendrin, and Broussais, have 
ascertained that immediately after the application of any irritating substance to 
a susceptible surface, the circulation in the vicinity of the stimulated part be- 
comes much more rapid, while the calibers of the vessels become considerably 
diminished. But at a certain period, after the irritation has caused an increased 
flow of blood to the part, other phenomena present themselves. The capillaries 
become gradually enlarged; the circulation becomes retarded, and if the conges- 
tion continue the blood becomes stagnant. But should the congestion be dimi- 
nished, the blood gradually recovers its mobility, and the dilated vessels recover 
their natural size, and the circulation resumes its wonted activity. It was, how- 
ever, found that a second stimulus to the congested part served to dissipate the 
accumulation of blood caused by the first stimulus. Hence, the utility of this 
moderately stimulating collyrium in the stage of the inflammation at which it is 
recommended. The nitrate of silver in solution, in the proportion of one grain 
to the ounce of distilled water, is highly spoken of in this state of the inflamma- 
tion. 



280 OF ULCERATION OF THE MOUTH. 



CHAPTER X. 

OF THE ULCERATION OF THE MOUTH. 

1037. Children are frequently troubled with ulceration of 
the mouth: it oftentimes confines its attack to the inferior por- 
tion of the fraenum of the tongue. It usually commences by a 
small inflamed point, and pretty rapidly extends itself along the 
inferior margins of the tongue, or rather the loose cellular por- 
tions of the skin to which the tongue is united — it seldom attacks 
the tongue itself, and for the most part confines its ravages to 
the gums, but especially to the cheeks, and the frsenum and its 
dependencies, where it most commonly commences. The edges 
of the sores are generally pretty high, and much inflamed, and 
the ulceration deep in proportion to its surface, and very pain- 
ful. 

1038. The child is first noticed to slaver very much, and to 
become fretful and uneasy, especially when it is about to take 
the nipple, which it frequently seizes, and then lets it go with a 
whining cry, as if in pain. Fever almost always is present at 
the beginning of the complaint, but pretty soon subsides after 
the ulceration has taken place, and the drivelling has become 
pretty considerable. The bowels are almost always confined, 
and the palms of the hands usually warm. 

1039. The complaint is generally of pretty easy management, 
if it be attended to at a proper time, or before the ulceration is 
extensive. Before we use any topical application for this com- 
plaint, and particularly if the febrile state be not passed, we 
should purge the child freely by magnesia, or small doses of 
calomel, and this plan should be continued until the system be 
free from fever. After the bowels are well emptied, or there is 
no longer fever, we may use topical applications with great pro- 
fit. The following has, so far, never failed us : — 

R. Sulph. Cupri. gr. x. 

Pulv. C. Peruv. opt. - - £ij. 

G. Arab. - gj. 

Mel. Commun. - spj. 

Aq. Font. - - - § iij. M. et f. sol. 

The ulcerations are to be touched with this mixture and solution 
twice a day, with the point of a camel's hair pencil. This has 
always speedily put a stop to the disease. 

1040. There is another ulceration of the mouth, and espe- 
cially the gums, which takes place in children who are cutting 
their teeth, and particularly the back teeth, when a number are 
about to make their appearance together; this is a very differ- 



INFLAMMATION AND SWELLING. 281 

ent state of the mouth from the one just noticed. In this com- 
plaint the gums become swollen, very dark-coloured, and spongy; 
they bleed from the slightest force; the child drivels constantly; 
the breath is extremely offensive ; and there is always more or 
less difficulty in swallowing. The teeth that are cut at the time 
soon decay; and those which were through before the ulceration 
commenced become injured. We have rarely found any other 
treatment necessary, than cutting the gums, and having the 
mouth frequently washed with a pretty strong decoction of bark. 

1041. Dr. Underwood calls this affection of the mouth aphtha 
gangrenosa, and has given a very good general description of it; 
but why it should be classed with aphtha, we are at a loss to 
understand. For the aphthous appearance spoken of by Dr. 
Underwood we have never witnessed — that is, we have never 
seen real aphthie attend this complaint. We have frequently 
observed the little dark-coloured sores he speaks of, but they do 
not bear the slightest analogy to aphthse. It is a disease of the 
gums, arising from cutting the last of the first set of teeth — it, 
therefore, never attacks after this process is completed ; or, at 
least, not until the teeth of second dentition are about to appear. 
The gums first swell violently, and become of a very dark red ; 
they are so extremely tender as to make the child refuse its 
food, or sometimes even the mildest drinks. After the inflam- 
mation has continued several days, the parts of the gums imme- 
diately over the teeth, about to be protruded, give way by 
ulceration to a greater or less extent. Other portions of the 
gums will now be subject to the same process, so that nearly 
the whole mouth will be in a state of ulceration. 

1042. This disease, Dr. Underwood says, is never dangerous ; 
we have never seen a fatal termination of it ourselves; though 
we have seen it protracted to a great length of time, especially 
with children who have had bad teeth. 



CHAPTER XI. 

INFLAMMATION AND SWELLING OF BREASTS OF NEW-BORN 
CHILDREN. 

1043. It occasionally happens that children newly-born are 
found to have their breasts swollen, and evidently inflamed. 
This exists in various degrees, from a slight tumefaction to one 
that threatens suppuration. 

1044. There is a vulgar opinion that these enlargements 



282 INFLAMMATION AND SWELLING. 

proceed from a quantity of milk within these little bodies, which 
must be squeezed or milked out, that mischief may not follow. 
This absurd opinion has, unfortunately, led to the preposterous 
and mischievous practice just alluded to; in consequence of 
which the parts have become so irritated as to occasion much 
pain and increase of inflammation. The little tumour has been 
violently pressed with the view to force out impacted milk ; but, 
being disappointed by its not appearing, the pressure is renewed 
again and again, and each effort with an increase of force ; since, 
agreeably to them, if the cause be not removed, serious conse- 
quences will follow to the parts, and, perhaps, in females, forever 
destroy their usefulness. In thus pursuing a bad theory, by a 
worse practice, the consequences which they so much dreaded 
have absolutely taken place ; suppuration has sometimes followed 
these rude manoeuvres, and has forever destroyed the organiza- 
tion of these most useful parts. 

1045. Or, should the inflammation be controlled by the use 
of suitable remedies, and thus prevented from running on to 
suppuration, still so much mischief has been done these parts, 
by rough handling, as to destroy their organization, or so much 
to injure it that they never can serve the purposes for which 
they were intended. 

1046. It cannot, therefore, be too peremptorily forbidden, 
that these parts should be meddled with ; for all that is necessary 
to their restoration is a little time ; or the application of a piece 
of linen, moistened with a little sweet oil, unless the tumours be 
unusually large, and the inflammation very considerable. In 
this case, a bread and milk poultice, renewed every three or 
four hours, will be almost sure to restore them to health in a 
few days. 

1047. We have never seen any other treatment necessary, 
where the parts had not been ill-managed by an ignorant and 
over-officious nurse ; but we have, in two instances, after mis- 
management, been obliged to leech the parts, and continue poul- 
ticing for some time after. It would be difficult to say how 
these swellings are formed, especially as they are almost always 
congenital, or rather connate. I will add the following inte- 
resting case. I was called to a child of two weeks old, who was 
extremely ill, crying most bitterly. Upon inquiry, I was told 
the "child was in so much pain from its breasts; they were so 
much inflamed and swelled from the milk not having been able 
to be squeezed out." Upon looking at them I was truly asto- 
nished at the ravages disease had made in consequence of the 
rude treatment the poor child had been subjected to. The breasts 
were enlarged to the size of a large walnut with the shell off, and 
filled with pus ; all parts adjacent were in a state of high inflam- 
mation and extremely tender. I was obliged to open them both 



OF DENTITION. 283 

immediately to discharge the pus, lest they should open them- 
selves unfavourably, and had a poultice applied to the breast. 
They got -well after much trouble, but ' the whole of the paren- 
chyma of the breast suppurated out, and entirely destroyed the 
usefulness of the breasts, as breasts. The wretched creature who 
was the cause of this was made duly sensible of her improper 
Treatment, and was discharged forthwith, with a severe repri- 
mand. 



CHAPTER XII. 



OF DENTITION. 



1048. We have already spoken (page 180) of this operation, 
as one among the important acts of the system ; therefore, we 
shall not repeat here the order of the appearance of the teeth, 
nor the process by which this change in the condition of the 
mouth is effected. We shall now confine ourselves to the morbid 
phenomena of this process, and the best modes of relieving them 
when they occur. 

1049. One of the most remarkable circumstances attending 
teething is the variety of sympathetic affections it gives rise to ; 
so that from the number, and oftentimes from their severity, 
this act of the system is one of great suffering, as well as often- 
times one of great danger. 

1050. The calculations of the mortality of children at this 
period, have always to us appeared to be excessive; some, as 
Dr. Arbuthnot, making it one in every ten, others, one in every 
six. That many children die at this time, must be acknowledged ; 
but it should be recollected, that, at this period of life, children 
are subject to many other complaints, besides teething, to which 
they may fall sacrifices. Yet we are willing to admit that the 
act of teething, abstractly considered, has sometimes severe 
penalties attached to it; and but too frequently disturbs the 
system, and calls into action many latent dispositions to disease, 
which otherwise might have slumbered to a more remote period, 
or have been finally overcome — therefore, in most instances, 
teething is but indirectly concerned in producing the formidable 
mortality of children at this age. 

1051. Teething is instrumental, sometimes, in producing death, 
by the condition in which the act itself places the system ; by 
exciting fever, or by disturbing the natural functions of the ali- 
mentary canal ; therefore, when the child is attacked by any acute 
disease, that disease is almost certain to be aggravated by the 
existing condition of the system. Hence the mortality of the 



284 OF DENTITION. 

small-pox, measles, whooping-cough, &c, at this period. Yet it 
cannot be truly said that many diseases are necessarily connected 
with the acquisition of teeth. 

1052. The same may be said of certain chronic affections ; as 
scrofula, glandular swellings, consumption, rickets, &c. If either 
have been developed before this period, they are now sure to be 
aggravated, and the child but too frequently succumbs ; or, if 
they have not been previously developed, they are now but too 
often called into action. 

1053. The system at the period of teething is more irritable, 
as well as more feeble, than in the after periods of life — hence, 
when several teeth are making their way through the gums at 
once, it will suffer more than when this process proceeds slower ; 
and if the body at this moment be attacked by fever, or convul- 
sions ; or if there be a disposition to either, they may be aggra- 
vated, if present, or called into action, if predisposed by the 
condition of the gums. 

1054. But the teething should not be chargeable with these 
contingencies; since it is itself altogether a functional process, 
as much so as the formation of the bones in other parts of the 
system, or of any other parts belonging to the human body. 

1055. There are two states of the constitution which may 
render this period one of greater suffering, or even of danger, 
than where neither of these obtain — namely, where there is a 
decided and marked feebleness ; and where there is evidence of 
a preternatural susceptibility to stimuli, though there may be 
the appearance of great vigour, and firmness of constitution. 
Now, should these states* not be relieved, as they may be, by 
proper physical treatment, the act of teething may create much 
mischief by its operation upon both the nervous and sanguiferous 
systems. 

1056. We have, in the first part of this work, directed the 
best mode of management for these two different temperaments 
— the first should enjoy a pure and temperate atmosphere, both 
at home and abroad; strict attention to cleanliness; proper diet 
or nourishment, and especially that of a mother or nurse ; well 
regulated clothing ; so that they shall not suffer too much by 
the winter's cold, nor be too much oppressed by the summer's 
heat ; and by well-directed exercise. 

1057. The other must have its excess of irritability diminished 
by withdrawing every thing capable of fostering it ; as too uni- 
formly warm a temperature; by the abstraction of all unneces- 
sary stimuli from within, as that of animal food, spices, and 
liquors of every kind ; by not sleeping too warm at night, or too 
long indulgence of bed in the morning; by a regular and effi- 
cient exercise ; especially such as will agreeably occupy the mind, 
as well as employ all the muscles of the body, &c. (See Chap, 
on Exercise, p. 200.) 



OF DENTITION. 285 

1058. We are, however, not to be understood as underrating 
the dangers attendant upon teething; and though we are not 
disposed to consider teething in itself a disease, we are, never- 
theless, well aware it invites such as may not be present, and ag- 
gravates those absolutely existing; consequently, it must be 
considered as a period of great moment to the poor child. On 
this account it is every way important to point out both the ex- 
tent of the influence of this act, and the numerous morbid sym- 
pathies to which it may give rise. 

1059. We have already described the order in which the teeth 
make their appearance, (Book I. Chap. VIII. p. 177,) and pointed 
out the principal local phenomena which accompany this func- 
tion : we shall now advert to some of the most common morbid 
sympathies by which it is attended. These are, 1st, eruptions 
on the skin, especially on the face and scalp; 2dly, tormina of 
the bowels, accompanied by a diarrhoea with various-coloured 
stools, as green, very pale yellow, clay-coloured or a peculiar 
dark brown, which leave a very permanent stain of a black co- 
lour upon the diaper; 3dly, spasms in various parts of the body, 
especially when passing from the waking to the sleeping state, 
or starting when asleep ; 4thly, an increased or diminished quan- 
tity of urine, of various complexions, attended with great pain 
in making it, and sometimes a discharge resembling pus from 
the urethra; 5thly, partial palsy of the arms or legs; Gthly, 
cough and difficulty of breathing; 7thly, convulsions; 8thly, 
fever, &c. We once saw a case where violent Grouping symp- 
toms would appear whenever a tooth was about to be cut ; and 
these would cease when the gums were scarified, or when a tooth 
would come through. 

1060. As a general remark, it may be observed that the 
children of the firmest constitutions cut their teeth the earliest 
and the easiest — we must, however, admit exceptions to this rule. 
We have lately had under our care a child with a diseased spine, 
who cut a number of teeth before she was four months old. We 
have already noticed the departures from this rule, as well as 
the one which governs the order in which the teeth make their 
appearance. (See Book I. Chap. VIII. p. 177.) 

1061. We have never distinctly perceived the advantage of 
very early dentition ; for if it be a sign of more vigour of con- 
stitution, it nevertheless has, from this very cause, its penalties 
— hence, the frequency of fever, and other diseases of irrita- 
tion. 

1062. Much of the difficulty that attends painful dentition 
may be removed, as already suggested in various parts of our 
first book, by a proper attention being paid to air, exercise, food, 
bowels, &c. ; for if these be duly regulated, the system will be 
less disposed to morbid action; though the local symptoms, such 



286 OF DENTITION. 

as swelling, redness, and inflammation of the gums, be considera- 
ble : and if proper care be bestowed upon the mouth, the force 
of the latter symptoms may be very much abated. 

1063. Indeed, this important part of parental and medical 
duty should never be lost sight of; the mother should carefully 
inspect the situation of the child's mouth from time to time ; 
and should she discover a swollen gum, she should immediately 
have it attended to, and not wait for constitutional symptoms to 
appear, before she employs proper aid for her child. 

1064. Should she not be familiar with the appearance of the 
gums under distention and inflammation, she will, at least, be 
aware that this condition is accompanied by slavering, heat of 
the mouth, &c. ; which should give rise to the suspicion that the 
eruption of teeth is about to take place, if the age of the child 
will justify the supposition ; or, if it have some teeth, that others 
are about to appear. 

1065. However truly the slavering of children may denote 
the Cutting of teeth in general, the rule is not infallible. We 
have seen children drivel largely at three months old, and con- 
tinue to do so for months, without a single tooth making its ap- 
pearance. From this circumstance we are led to believe this 
sympathetic affection may denote the formation and hardening 
of the tooth, as well as its being about to pierce the gum; for 
when the investing membrane of the tooth is put upon the 
stretch by the increased size, and hardening of this body, it may 
possess an unusual degree of irritability, or sensibility, and thus 
give rise to several of the premonitory symptoms of this opera- 
tion, before 8 the gums are at all acted upon by its presence — 
hence the slavering, the frequent thrusting of the fingers into the 
mouth, &c. 

1066. We have thought it proper to state this fact, because 
we have seen it produce much anxiety in parents ; especially if 
the subject be a first child; and it sometimes leads, at this mo- 
ment, to the unnecessary expedient of having the gums of the 
child cut, before the lancet can well reach the crown of the tooth, 
however deep the incision may be. We would, therefore, wish 
to spare the poor infant this unprofitable pain, since it is both 
unnecessary and unavailing; for we have seen the whole of the 
symptoms for which the operation was performed, continue with 
as much pertinacity, after this has been done, as before the gums 
were incised: therefore, this operation should not be had re- 
course to, without the advice of a physician. 

1067. One of the most important indications to be fulfilled 
during teething is to diminish the local irritation arising from the 
protruding tooth or teeth ; and this should be attended to as early 
as may be, that as few constitutional symptoms mpy be provoked 
as possible. 



OF DENTITION. 287 

1068. For this purpose the gums should be carefully inspected; 
and the portions of them in which teeth are due, or even supposed 
to be due, should be well examined ■, that any change in their colour 
or size may be detected, in order that the only appropriate remedy 
may be applied in proper time. We have laid down (Book I. p. 
17Jy the order which nature usually pursues in the performance 
ofthis process: therefore, a person acquainted with this will 
rarely fail to detect the point from which the irritation proceeds. 

1069. It must, however, be observed, that as far as our ob- 
servations extend, the lower teeth, when they are the first, (as 
they should be,) that make their appearance, rarely require to 
be cut; whereas, the upper frequently do, whether they have 
come at their regular period, or have anticipated the lower ones. 

1070. If, upon the examination of the mouth, the gums are 
found to be swollen and inflamed, the imprisoned tooth or teeth 
should be set at liberty by cutting through them until the tooth 
is felt. This operation becomes the more necessary, when the 
local irritation has not been relieved by the natural means, namely, 
by a salivation or slavering, or by a diarrhoea; and especially so, 
when, instead of a copious discharge of saliva, the mouth is found 
hot, dry, or clammy, and the bowels tardy. Under such circum- 
stances, no time should be lost; the gums should be amply in- 
cised, and the child liberally purged, or we may expect some 
severe constitutional affection to follow; and, if the child have 
been habituated to liberal feeding, and that of animal, or other 
stimulating food, it must be immediately withheld, and be con- 
fined to the breast milk alone, if it be not weaned; and, if 
weaned, it should be allowed nothing but milk, or milk and water 
sweetened. 

1071. We are persuaded, were proper attention paid to the 
child at this time, many of the evils arising from dentition would 
be avoided ; but unfortunately the friendly admonitions of nature 
are either neglected or overlooked by the greater number of 
parents. The efforts which nature makes at this time are all 
calculated to prevent fever, or unnecessary local inflammation ; 
accordingly, a great quantity of saliva is poured from the mouth 
by the irritated salivary glands, that the vessels of the part may 
be unloaded; the appetite of the child is diminished, that less 
food may be taken, and the general system is reduced by a co- 
pious spontaneous diarrhoea. Thus, nature declares in plain but 
emphatic language, what she requires to aid her; nor ought she 
to speak in vain. 

1072. To co-operate, then, with this beneficial intention, let 
the child be put upon a mild and moderate diet, as just directed ; 
and on no account be permitted either to eat or drink any thing 
which has a tendency to stimulate the system. Let its bowels 
be carefully watched, that they may not become confined, or, if 



U88 OF DENTITION. 

they be so, let this condition be removed by an appropriate diet, 
or by gentle laxatives. 

1073. We have found a liberal use of molasses, when there 
was a tendency to constipation, of great service: this may be em- 
ployed in several ways, as may best suit the particular habits of 
the child. If it be confined to the breast altogether, it will, never- 
theless, drink freely of this substance when mixed with water. 
If it feed in part, its milk or its milk and water may be sweetened 
with it ; or, if weaned, it may eat it on bread, or take it in any 
other practicable manner. 

1074. Should the molasses not be sufficiently aperient, half an 
ounce of flake manna may be given in any victuals which may 
require sweetening; and, should this prove insufficient, a like 
quantity may be given in a few hours more. But should the 
symptoms of irritation not be relieved by this plan, a little calo- 
mel may become necessary. 

1075. But it must be evident that little relief can be afforded 
by any general applications, so long as the membranous expan- 
sion over the tooth remains entire — therefore, nothing but a free 
incision to the crown of the tooth can relieve the little sufferer. 
And it is often not less wonderful than delightful, to witness the 
complete relief it affords. We have often observed excessive 
fever, and a threatening irritation, subside almost instantaneously 
after cutting the gums. 

1076. Notwithstanding the decided advantages resulting from 
cutting the gums, many are prejudiced against it : and will not, 
but with great reluctance, permit their children to undergo the 
operation, though they can cite no instance in which it has been 
attended with any mischievous consequence. The objections to 
cutting the gums, are, 1. That it is painful. Every body who 
has performed this operation with a proper instrument, and that 
in proper order, knows the contrary to this. In the first place, 
the gum is not at any time a part of exquisite sensibility ; and, 
secondly, the speed with which the instrument passes through, 
and the decided relief it almost invariably affords, at once pre- 
vent any complaint on the part of the patient. This, however, 
maybe considered but negative proof: if so, we have sometimes 
the most positive evidence that the operation cannot be painful, 
in the children themselves asking for it to be performed. Our 
own children have repeatedly solicited this kind office at our 
hands. 

1077. 2. It is said it requires much judgment to perform this 
operation; for if it be done too soon, it will afford no relief, be- 
sides making the tooth cut with more difficulty, by its leaving a 
hard scar. As regards the degree of judgment necessary in this 
case, we should think it very limited indeed, if, upon inspecting 
the mouth, the person could not discover whether the gums were, 



OF DENTITION. 289 

or were not, altered from their natural condition; if they were, 
it is at once evident that the tooth is producing irritation or in- 
flammation, by its pressure against its coverings, and, therefore, 
they should be cut through. And though the tooth cut upon 
may be yet remote from the surface, still the operation may be 
of the greatest possible advantage, by dividing the membrane, 
now severely put upon the stretch, and from which the whole 
irritation proceeds. When this membrane has been once di- 
vided, it never unites again ; and though the crown of the tooth 
may not show itself for a long time, yet the irritation ceases, 
and the disturbance of the system is quieted from the moment 
the gum is divided. 

1078. It is true the gum will heal if the tooth be not very 
near — but this is of no consequence ; as its healing oifers no in- 
crease of difficulty to the passing tooth. Every body knows that 
the second teeth are always more easily cut than the first; yet 
these teeth have to pass through denser cicatrices than the first; 
as by the drawing or falling out of the first teeth, much larger 
wounds are made in the gums; consequently, larger scars are 
left after their healing. 

10T9. And if the gums be not changed, still the operation of 
cutting may be highly advantageous, and should always be tried 
in severe cases, as the irritation sometimes begins as soon as 
the tooth itself begins to swell. We have many times had oc- 
casion to prove the truth of this; therefore, the objection to 
cutting the gums, lest the scars may do mischief, is without foun- 
dation. 

1080. 3. Lancing the gums has been objected to, from a fear 
that cutting on them may do injury to the teeth, by producing 
caries, and thus be injurious to the set below. But this cannot 
happen: — 1. Because if the lancet do touch the tooth, it can do 
no injury, as its hard enamel, which it possesses before the tooth 
is about to be cut, will entirely protect it against such a conse- 
quence. 2. If it really did dispose the tooth so touched to be- 
come carious, it would do no injury to the teeth which are to 
succeed them, because they are not in contact with each other. 

1081. The gums of such children as have not been lanced 
are more disposed to be ulcerated than those gums which have 
been cut. 

1082. It may be well, however, to remark, that when this 
operation is to be performed, it should be done with a bold hand 
and a sharp instrument ; for if the tooth producing the irrita- 
tion be not cut down to, so as to be distinctly felt by the lan- 
cet, the operation will be of little avail. The mere bleeding of 
the gum answers little or no purpose ; and, failing in the inten- 
tion for which it was proposed, only brings the operation into 
discredit, besides prolonging the sufferings of the little patient. 

19 



290 OF ERUPTIONS. 

1083. When the double teeth are about to be cut, they fre- 
quently show themselves by one point piercing the gum — over 
the other portions of the tooth the gum remains, and is very ten- 
der; so much so is this the case sometimes, that the child will 
refuse every kind of food which may require chewing. In such 
case the gum should be freely cut across, and thus liberate the 
crown of the tooth. 

1084. When a tooth which has been cut upon is remote from 
the surface, or the absorption of the gum goes on tardily, it will 
sometimes swell, and become very tender. When this is per- 
ceived, it should again be cut; and this, repeatedly, as often as 
new necessities may arise. 

1085. The best mode of performing this operation is by having 
the child held horizontally, with its head resting upon the ope- 
rator's knee — the hands of the child must be secured by the as- 
sistant, and the lower jaw depressed and held firmly, while the 
lancet is introduced to that part of the mouth where the pained 
gum is ; the edge of the instrument is then made to traverse the 
tooth, by an incision sufficiently deep to reach the tooth, which 
must be so distinctly felt by the operator as to satisfy him that 
nothing is left interposing between the lancet and the tooth. If 
the operation be properly performed, it gives no pain to the child 
— on the contrary, we have known them to cease crying the in- 
stant the instrument penetrated the gum. 



CHAPTER XIII. 

OF THE DISEASES ARISING FROM DENTITION. 

1086. Though we have perfectly agreed with Drs. Cullen, 
Struve, and others, that teething in itself is no disease, yet we 
are aware that many affections of childhood are dependent upon 
this operation either for their existence or augmentation. It 
would be unavailing, as well as injurious to the interests of so- 
ciety, did we attempt to shut our eyes against truths no less im- 
portant than palpable. We, therefore, fearlessly entitle certain 
affections of the body at this period, "diseases of dentition." 
We shall place the various complaints promiscuously, since they 
observe no regular order; nor is the same child liable to the 
whole; though we have occasionally seen two, three, or even 
more, united. As eruptions of various kinds are very frequent, 
we shall commence our histories with an account of them. 



OF CKUSTA LACTEA. 291 

Sect. I. — Of Eruptions. 

1087. It is notorious to common observation, that a child, for 
the first two years of its life, is especially liable to affections of 
the skin. It is not our design to notice them all, or to enter 
into any nosological arrangement of them — we merely intend, in 
this place, to speak of such as appear evidently to be connected, 
in some way or other, with dentition. We shall, therefore, first 
notice, 

A — The Crusta Lactea, or the Milky Scall. 

1088. Dr. Good 1 supposes that this disease has acquired its 
name from the " milky, or rather the creamy appearance and 
consistency of the discharge." But as we have never witnessed 
this "creamy appearance," to justify the name, we should rather 
suppose it has been given to it, from the circumstance of its 
generally appearing during lactation. At all events, it is a dis- 
ease, we believe, exclusively belonging to infancy. 2 

1089. This complaint begins sometimes sooner, and at other 
times later, as the disposition of the system to protrude the teeth 
may exist ; for we never remember to have seen it before den- 
tition had commenced, nor after it was completed. 

1090. It usually begins upon the cheek, or near the centre of 
the forehead; it first shows itself by an assemblage of small 
whitish pustules upon a very red surface ; these gradually change 
to yellow, and brown, which presently break, and form a scab of 
greater or less density, from which proceeds an ichorous dis- 
charge. ]New pustules soon appear, which, after having under- 
gone the change just spoken of, unite, as it were, w T ith the for- 
mer, and thus gradually travel to various parts of the body ; but 
the face, scalp, and neck, are particularly liable to it. We have 
seen it cover nearly every part of the cuticular system. When 
it is even very general over the face, it is a little remarkable 
that it never attacks either the nose or the eyelids. 

1091. There is a considerable variety in the intensity of this 
disease; it sometimes confines itself to very narrow limits; at 
others, it will be very extensive. We have seen it occupy the 
cheeks alone; at other times the forehead; but more frequently 
both. Sometimes the discharge is very acrid and profuse, leaving 
the surface of the skin both red and excoriated; at other times, 
the quantity discharged is small and mild, leaving the surface 
covered with a brownish dry scab. 

1 Study of Medicine, Vol. IV., p. 422. 

3 We are well acquainted with a family of five children, who have all, in suc- 
cession, had this complaint. It sometimes begins as early as the sixth month, 
and continues for twelve months, or even longer. We believe no attempt was 
made to relieve this formidable eruption in these cases. 



292 OF CRUSTA LACTEA. 

1092. When the scab drops off, and does not reappear, the 
cuticle is found tender, red, a little elevated, and marked bj fis- 
sures — this pellicle exfoliates, perhaps, several times. It is said 
the skin never cracks into deep fissures, as after some other 
eruptions. 

1093. This complaint is generally considered more trouble- 
some than dangerous ; yet we have seen two instances of death, 
evidently from this disease. In these cases, the itching was un- 
ceasing during the day and night ; the children were worn down 
from the want of rest, as well as exhausted from the excess of 
discharge. The eruption covered the whole body, and continued 
without amendment for many months, until the children were 
destroyed by the pertinacity of fever and the profuseness of 
diarrhoea. 

1094. Some, indeed, believe it only dangerous when its pro- 
gress or duration is interfered with; and, therefore, deprecate 
every attempt at cure. We are, however, very far from this 
opinion, because we believe it to be founded in error. They ask, 
" Why should we meddle with a complaint which is evidently an 
effort of nature to get clear of a greater evil ? Moreover, it is 
never a dangerous disease ; nor does it ever leave unseemly marks ; 
and if attempted to be dried up, will certainly prove injurious 
to the child." 

1095. We shall take the liberty of making a few remarks upon 
each of these positions. What evidence is there of this being a 
critical eruption, any more than convulsions are critical spasms, 
or that fever is an effort of nature to get clear of some noxious 
agent ? Yet who, without an effort to control convulsions, will 
see a child expire, because they are produced by teething ? — or 
who will look on, and see it consumed by fever, without attempt- 
ing to afford relief, because it arises from the irritation of pro- 
truding teeth. 

1096. As to its never being a dangerous disease, we have 
just stated that we have seen two instances of death from crusta 
lactea : but, suppose it were not dangerous — are we to suffer a 
poor child to bear with a . loathsome and troublesome disease, 
without any attempt to remove it, because the disease will not, 
perhaps, terminate in death ? Why should any of the non-fatal 
diseases of infancy be meddled with, since they will not kill, 
however troublesome they may be, or however interminable may 
be their duration? 

1097. And because it takes its departure from the body after 
a troublesome visitation of many months, and leaves no unseemly 
scars, the poor infant is to be left to contend with affliction, and 
bear with its ravages, the whole of that period, merely because 
it will not leave its mark behind ! 

1098. It is asserted, when an attempt is made to cure this 



OF CRUSTA LACTEA. 293 

complaint, and we succeed in drying it up, that it has always 
proved decidedly injurious to the child. 

1099. As this is a broad assertion, and one that is confidently 
believed by many, it will be well to examine into its truth, when 
a cure is attempted under proper circumstances. 

1100. We will first inquire into the nature of the eruption. 
The skin, like every other organ of the body, has predispositions 
to disease, peculiar to its structure. These predispositions may, 
however, lay dormant for many years, or forever, if the appropri- 
ate exciting cause be not applied, to call them into a state of 
actual disease. Before they are awakened into a palpable form 
the system suffers neither inconvenience nor injury from this 
mere disposition to disease; but as soon as any circumstance 
shall convert this disposition into morbid action, the part thus 
acted upon will suffer in a degree proportionate to the extent 
and nature of this provoked disease. Therefore, in the case 
under consideration, the cutting of the teeth rouses the latent 
disposition into action ; and the skin is now made to suffer under 
an active disease. 

1101. This being certain, we must now inquire, is the eruption 
in question a consequence of a critical effort of the system to 
relieve some other portion of the body of an existing disease ? 
— or, is it a mere consequence of some specific irritation ? If 
the first part of this question be answered in the affirmative, it 
must then be shown that it has ever fulfilled the intention for 
which it was instituted. Can this be shown? We believe it 
cannot; for the local irritation in the mouth continues without 
abatement, however copious this eruption may be; it would, 
therefore, appear it was not intended to remove, or even di- 
minish, the consequences arising from the protrusion of the teeth 
through the gums, or, if it were, it fails in the object; therefore, 
it must be contingent, and not critical. 

1102. But it may be said they are cause and effect, and in this 
relation they must be considered. Let this be admitted — their 
connexion will then stand thus : there is a disposition in the skin 
to crusta lactea, but this disposition requires some exciting cause 
to bring it into action : and this exciting cause is the irritation 
of teething; hence, this disease only appears during infancy, and 
even then rarely. 

1103. But would it not seem extraordinary, that so loathsome 
and obstinate a disease as the one in question, should be insti- 
tuted to relieve one of an infinitely milder grade ? If this disease 
were a constant attendant upon teething, and teething were 
found to be less severe, and less hazardous, by its appearance, 
there might be some reason for inviting its presence, or fostering 
its continuance on the surface of the body: we, therefore, con- 
clude, that, however intimately some affections, at the period of 



294 OF CRUSTA LACTEA. 

teething, may be connected with this process, the one we are now 
considering must not be ranked among the number. 

1104. The next question is, will the child suffer by the de- 
struction of the crusta lactea? We unhesitatingly say, No — 
provided this be attempted in a proper time, and in a proper 
manner — at least this is the conclusion to which ouy own expe- 
rience would lead us. If children have suffered from attempts 
to cure this loathsome eruption, the injury was altogether of an 
artificial kind ; and made to arise from employing remedies for 
suddenly extinguishing the disease after the system had become 
habituated to the waste from its surface. In attempts of this 
kind, we readily believe injury might be sustained ; but this does 
not prove the critical nature of the disease in question; it only 
goes to show, that when a drain of this or any other kind is 
established, it must not be suddenly suppressed. 

1105. We see this well illustrated in ulcers of every kind, 
which are of long standing ; but is there any one who would have 
hesitated to heal the fresh wounds from which these sores origi- 
nated? We think not — yet no one of real experience would do 
this after they had become confirmed drains, without first estab- 
lishing some compensating change in another part of the body; 
or so gradually have encroached upon the daily waste, as not to 
be perceived by the system. This is precisely the case with 
crusta lactea. 

1106. For these reasons, we do not hesitate to attempt the 
relief of crusta lactea; especially when we see it early, (that is, 
when it is confined to the cheeks and forehead of the child,) and 
that by the most prompt remedies. We direct the diminution 
of nourishment of every kind, and never permit any in which 
animal food enters. If the child be still at the breast, we re- 
quest it to be nursed less frequently ; and, sometimes, even con- 
fine the mother, or nurse, to a strictly milk and vegetable diet. 
If it be weaned, we forbid every stimulating article, and direct 
a reduction of its milk ; confining it to thin arrow-root, with very 
little milk, or to the rennet whey. 

1107. At the same time, we order small doses of sulphur, or 
sulphur and magnesia, to be given as frequently, and in such 
quantities, as shall keep the bowels loose, but not severely purged. 
After persevering in this plan for a week, we almost always find 
an abatement of redness at the margins of the scabs, and dimi- 
nution of the itching. 

1108. After having purged the bowels with sulphur, or sulphur 
and magnesia, for a few days, as above directed, we then com- 
mence with small doses of calomel, as follows — 

R. Calom. pp. gr. x. 

Creta. pp. 9j- M. div, in xx. par. 



OF CKUSTA LACTEA. 295 

1109. One of these powders is directed to be given every 
morning and evening in a little molasses or syrup of any kind. 
Should they prove too purgative, from half a drop to a drop of 
laudanum is added to each dose. Should they not move the 
bowels sufficiently, an additional powder is ordered. 

1110. We pursue this plan for at least a fortnight, before we 
make any local application ; and, indeed, we do not apply them 
then, unless there be an abatement of the inflammation and 
itching, as above remarked. But should both these have hap- 
pened, we commence with the calomel ointment ; ' but confine its 
application to some one spot of diseased surface. When this 
becomes relieved, we select a second, and so on until all are re- 
lieved. But let it be remembered that the calomel powders are 
continued through the whole course of the disease, and even for 
some time after, if the disease has been extensive and obstinate. 

1111. When this plan is duly persevered in, it rarely fails to 
succeed; nor have we ever seen a single instance in which any 
untoward symptoms have arisen. We have sometimes substituted 
the citron ointment, reduced one-half, for the calomel ointment, 
when the latter seemed to have lost its effect. When the dis- 
charge is considerably diminished, and nothing appears to re- 
main but the dry scabs, we almost always employ the tar oint- 
ment instead of either of those just mentioned — this may be 
applied twice a day. 

1112. The citron, as well as the tar ointment, must be had 
recourse to, as above directed, should that of the calomel not 
prove sufficient. Indeed, we believe it would always be best to 
finish with the tar ointment, as it seems to have a peculiar fa- 
cility in removing the scabs, and allaying the itching, which last, 
by the by, is one of the most troublesome attendants upon the 
disease. 

1113. Where the warm bath 2 can be had recourse to with 
convenience, it should be used two or three times a week, as it 
greatly promotes the efficacy of the other remedies ; and, during 
the whole period of the attempt at cure, and especially in the 
beginning, when the discharge is both copious and acrid, the 
surrounding parts should be washed with a mild solution of fine 
soap, even three or four times a day. We have thought we have 
derived advantage, where the discharge is free, from rubbing or 
smearing the sound skin immediately surrounding the sores, after 
washing, with a little fresh hog's lard and beeswax melted to- 
gether, to defend these parts against excoriation. 

1 R. Calom. ppt. gij. 

Cerate Simp. ^j. 

Ess. Lemon. gut. xx. M. 

3 We think that much advantage has been derived by substituting a pretty strong 
infusion of flaxseed for the plain warm water. 



296 OF TOOTH RASH. 

1114. This complaint is sometimes treacherous; after giving 
promise of a speedy departure, it will suddenly return, with re- 
newed force. Dr. Strack 1 has recommended the decoction of 
the Viola tricolor, Lin., or heart's ease, as a specific in this dis- 
ease ; but of this we can say nothing from our own experience. 
It might, however, in obstinate cases, be tried in conjunction 
with the remedies recommended above. He directs a handful 
of the fresh plant, or half a drachm of the dried leaves, to be 
boiled in half a pint of cow's milk, and this quantity given 
morning and evening. He affirms that, for the first week, it 
greatly aggravates the complaint ; but at the same time the urine 
acquires the odour of the urine of cats; and at the end of a 
fortnight the crusts begin to fall off, and the skin underneath 
appears clean. But when the usual smell of urine remains, the 
disease will generally be of long continuance. Prof. Selle, how- 
ever, has affirmed that this plant is either noxious or inert. 2 We 
have never perceived the smell spoken of by Dr. Strack. It 
may, however, be proper to observe, that in all our endeavours 
to relieve this complaint, as directed above, we have never wit- 
nessed any injury to arise from the attempt. 3 

B. — Tooth Rashes, 

1115. Nothing declares the intimate connexion, or play of 
sympathies between the gums and skin during dentition, more than 
the number of eruptions to which it becomes liable at that period. 
Authors, (Underwood, Bateman, &c.) have described, and we 
have seen, five or six different affections of the skin during the 
cutting of the teeth, all of which appear perfectly harmless, unless 
improperly treated. But as there are diseases of the system of 
a dangerous kind, which are accompanied with efflorescences, or 
pimples, much alarm is excited when any eruptions of analogous 

1 Bateman's Synopsis, p. 153. 

* Ibid. 

3 We have had lately, (January, 1828,) a very severe and interesting case of 
the crusta lactea in a child of sixteen months old. It commenced when the child 
was eight months old, in the common way, and spread gradually over the whole 
face, scalp, neck, body, and limbs. The child was feverish, restless, and almost 
constantly scratching both day and night. A variety of remedies were tried be- 
fore we saw it, without the slightest benefit. We commenced the cure by purges 
of sulphur and magnesia; confined the child to a diet of vegetable mucilages, as 
gum Arabic, tapioca, sago, rice, jelly, &c. Ordered a warm flaxseed tea bath 
every other day. After a fortnight's use of the sulphur and magnesia, the calomel, 
as directed above, was given, together with a pretty strong infusion of the dulca- 
mara. The sores were washed with the same infusion. After a perseverance in 
this plan for two months, an evident amendment was perceived in the nature and 
extent of the eruption. At this time we vaccinated the child : and this disease 
ran a regular and satisfactory course. After the vaccine scab dropped off, the 
sores healed very rapidly, by the use of the tar ointment. In the course of an- 
other month, the child was perfectly well, and remains so to this time, (May, 
1831.) 



OF RED GUM. 297 

appearance show themselves upon the surface. On this account, 
it may be well to give a short account of them. For this pur- 
pose, we shall employ the descriptions of Dr. Willan, as they 
appear to us to be perfectly well marked. 

1. Strophulus Confertus, or Tooth Bash, 

1116. " Is an eruption of numerous papillae, varying in their 
size, and appears on different parts of the body in infants, during 
dentition, and has thence been denominated the tooth rash. It 
is also termed, sometimes, the rank red gums." 

1117. "About the fourth or fifth month after birth, an erup- 
tion of this kind takes place, in most infants, on the cheeks and 
sides of the nose, extending sometimes to the forehead and 
arms ; at other times, though less frequently, to the trunk of the 
body." 

1118. This affection differs a little from the red gum, by being 
less vivid in their appearance, the pimples smaller, and more 
crowded together. We have repeatedly known this species ap- 
pear much later than is fixed by Dr. Willan ; and their produc- 
tion seems evidently connected with the process of dentition; for, 
when that process is retarded, this appearance is retarded: there- 
fore, the time at which they show themselves may be better fixed 
by saying that when dentition begins, they commence. Every 
child, however, is not subject to it. It is rarely attended by 
constitutional symptoms, and, consequently, requires but little 
medical care. This complaint is usually of about a fortnight's 
continuance. 

1119. We, however, almost always think it best, should there 
be any disturbance in the bowels, to give a pretty full dose of 
magnesia; to keep the skin clean and soft by washing with warm 
water, and to remove any irritating substance from the surface 
that is covered with the eruption, such as flannel or muslin, and 
substitute linen. When this is attended to, we think the course 
of the disease is shortened; for the pimples soon after are ob- 
served to fade, and cast off their little shells, and finally disap- 
pear. A decided advantage is obtained, we think, by rubbing 
the part with a little dry flour after washing, when it becomes 
perfectly dry. 

2. Strophulus Jntertinctus, or Red G-um, 

1120. This complaint is confined to early infancy, and espe- 
cially to "the month," as it is called. Very few children escape 
this complaint ; and most nurses are fond of seeing it — so much 
so, indeed, and so inevitable and useful do they consider its 
presence, that should any indisposition befall the child, and this 
eruption not have possession of the skin, it is at once attributed 



298 OF THE RED GUM. 

to the absence of the gum. With a view, then, to invite its ap- 
pearance, the child is kept unusually warm, and some stimu- 
lating tea is given it, such as of sweet marjoram, saffron, catmint, 
&c, and after having been thus disciplined for a longer or a 
shorter period, the poor child is but too frequently loaded with a 
heavy crop of "Red Gum." 

1121. This eruption, however, seems connected, in some way 
or other, with a derangement of the stomach and bowels. This 
derangement may proceed, 1st, from the meconium not having 
been well purged off, or its being of an unusually acrid quality ; 
2dly, it may proceed from an acid state of the stomach, owing 
to feeding the child with improper food ; or to its being made to 
receive too great a quantity of it ; to some ill quality in the 
mother's milk, or a constitutional feebleness of the stomach. 
Hence this complaint is commonly ushered in by nausea, vomit- 
ing, or diarrhoea ; 3dly, to the child being kept too warmly clad, 
or too warmly covered, especially its head, by which means it is 
obliged to breathe over and over again the same air ; and is also 
thrown into a profuse perspiration. We have elsewhere noticed 
this injurious practice. (Book I. p. 121, par. 445.) 

1122. This disease, for the most part, is rather provoked, than 
spontaneous ; for children who are kept in a moderate tempera- 
ture and who are dependent upon the breast for support, rarely 
have this disease, especially if the bowels have been well purged 
of the meconium, and the child is naturally of a good constitu- 
tion. 

1123. "The red gum or gown, occurs chiefly within the first 
two months after birth, and is characterized by papulae of a vivid 
red colour, situated most commonly on the cheeks, fore-arms, and 
backs of the hands, but sometimes universally diffused. They 
are usually distinct from each other ; but are mixed with red 
dots, or stigmata, and often with larger red patches, which have 
no elevation. Occasionally, a few small vesicles appear on the 
hands and feet; but these soon desiccate without breaking." 1 

1124. This disease, under ordinary circumstances, requires 
little or no medical treatment. It is, nevertheless, proper that 
due attention be paid to cleanliness, by daily washing with warm 
water ; and, also, if errors have been committed in either of the 
ways mentioned above, they should be immediately rectified. 
The bowels should be gently opened by small doses of calcined 
magnesia; and, if pain attend, a half or whole drop of lauda- 
num may be given. The cold bath improperly used, or even a 
strong current of cold air, may do mischief at this time. And, 
should this eruption be repelled from the skin, alarming symp- 
toms may immediately ensue ; such as great oppression and dif- 
ficulty of breathing, drowsiness, or incessant crying, and spas- 

1 Bateman. 



OF STROPHULUS VOLATICUS. 299 

moclic twitchings. The whole surface of the body is now pale; 
the pimples have all disappeared ; the child becomes blue around 
the mouth ; it refuses the breast ; and stretches itself out stiff 
its whole length, and then becomes suddenly relaxed; cold skin, 
&c. 

1125. The best remedy, under such circumstances, is the 
warm bath, in which the child should be immediately placed, and 
kept until its skin acquire warmth ; it should then be well dried, 
and wrapped up in warm flannel — at the same time some pretty 
strong sweet marjoram tea should be given, or any other mild 
stimulant of the kind. Dr. Underwood recommends two or three 
drops, three or four times a day, of the compound spirit of am- 
monia, and a blister between the shoulders. We have never 
seen either of these necessary. 

3. Strophulus Albidus, or Wliite G-um. 

1126. "This eruption consists of numerous minute, hard, 
whitish specks, a little elevated, and surrounded by a very slight 
redness. These specks, or papulae, when their tops are removed, 
do not discharge any fluid ; they appear chiefly on the face, neck, 
and breast, and continue a long time." 

1127. This affection rarely requires any medical treatment, 
unless it have been driven from the surface by a current of cold 
air, or the application of cold water. It is rarely if ever attend- 
ed with any constitutional irritation, and, therefore, while it pre- 
serves its mild form, deserves but little notice. But should 
mismanagement, or any other cause, have driven it suddenly 
from the surface, it may, like the red gum, [Strophulus inter- 
tinctus, which see,) be productive of inconvenience, or even of 
danger, and must, when this happens, be treated like that affec- 
tion when it has been repelled. It is, however, proper, in the 
species under consideration, that due attention should be paid 
to keep the skin free from all impurities, by washing with warm 
water. 

1128. Dr. Willan describes a variety of this complaint, which 
sometimes becomes very troublesome, though never dangerous. 
He declares it to be both painful and obstinate, yet requires no 
particular treatment, except that which is proper in all these af- 
fections; namely, cleanliness. We do not remember ever to 
have seen this variety as described by both him and Bateman. 

4. Strophulus Volaticus. 

1129. " This variety is characterized by small circular patches 
or clusters, of papula, which appear successively on different 
parts of the body. The number of papulae in each cluster is 
from three to twelve; both the papulae and their interstices are 



300 SORE EARS. 

of a high red colour. These patches continue red, with a little 
heat and itching, for about four days, when they turn brown, 
and begin to exfoliate. The eruption is, in many cases, limited 
to two or three patches on the arms or cheeks. In some 
instances, however, one patch declines, another appears at a 
small distance from it, and in this manner the complaint spreads 
gradually over the face, body, and limbs, not terminating in less 
than three or four weeks. During this time the child has usually 
a quick pulse, and a white tongue, and is uneasy and fretful." 

1130. We have several times seen this complaint ; but it has 
always, so far as we can recollect, appeared later than is usually 
described, or not until the child be about to cut the jaw teeth, 
or little molars. We have found it occasionally very trouble- 
some; and sometimes to require a treatment similar to crusta 
lactea, of which, in this situation, it has been considered, by 
some, as a variety. 

1131. As this complaint is usually attended by some derange- 
ment of the system, and particularly the bowels, attention should 
be paid to them. They must be treated agreeably to the state 
of the system: if fever attend, the diet should be diminished, 
if it be only milk — no animal food should be permitted in any 
form. The bowels should be purged with magnesia; and the 
calomel and ointments used, as directed for crusta lactea, (1107.) 
Should diarrhoea attend, it must be managed as directed for that 
complaint. 

5. Strophulus Candidus. 

1132. " In this form of strophulus, the papulae are larger than 
in the foregoing species. They have no inflammation around 
their base, and their surface is very smooth and shining, so that 
they appear to be of a lighter colour than the adjoining cuticle. 
They are diffused, at a considerable distance from each other, 
over the loins, shoulders, and upper part of the arms : I have not 
observed them in any other situation." 

1133. " This eruption affects infants above a year old, in the 
latter periods of dentition : it likewise occurs during the state 
of convalescence after fevers, and inflammation of the bowels 
and lungs. The papulae continue hard and elevated for about 
a week, then gradually subside and disappear." 

1131. This affection requires no medical treatment — the whole 
attention must be paid to the state of the gums. 

Sore Ears, 

1135. Children, during dentition, very frequently have slight 
pustules form behind the ears, which soon become ulcerous ; or 
look, oftentimes, like a superficial excoriation. This condition 



SORE EARS. 301 

of the ears also takes place before any suspicion of teeth being 
the cause can be entertained, especially in very lusty children. 

11 36. There are few eruptions which attack an infant more 
decidedly cherished than that producing sore ears; hence, what 
was but in appearance a very slight excoriation in the beginning, 
and which might readily have been healed by proper and fre- 
quent washing with warm milk and water, or fine soap and 
water, is permitted to degenerate into a painful, tedious, and 
oftentimes offensive ulcer : as its first appearance was welcomed, 
so is its continuance perpetuated, by various stimulating things, 
under the specious pretext of its being an important drain for 
the noxious humours of the body. 

1137. The sores being thus encouraged, eventually discharge 
a large quantity of both pus and serum : in a word, they are 
converted into "issues," which it is declared, on all hands, it 
will not do to dry up. This popular prejudice perpetuates an 
evil which should never have been permitted to have existed — 
for a sore is an evil, be it placed where it may, unless it be 
distinctly critical, which we deny this to be. The reasoning we 
employed when speaking of the crusta lactea will strictly apply 
here; and the motives which led us to the use of remedies in 
that complaint would influence in this — therefore, we never hesi- 
tate a moment to set about so desirable an end, nor have we 
ever witnessed, when properly managed, the slightest inconve- 
nience to follow the practice. Dr. Good says, " The discharge 
is often peculiarly offensive;" "it cannot be checked too soon; 
for if it continue for a few weeks, or, perhaps, even less, it may 
acquire a habit, the suppression of which may run the risk of 
superinducing some worse disease than itself, as dyspepsia, diar- 
rhoea, or convulsions." 1 

1138. We commence the treatment of this affection by regu- 
lating the diet of the child, if this be necessary — that is, if it 
be in the habit of using animal food in any form, we forbid its 
farther employment, and confine it to vegetables and milk, as 
rice, arrow-root, or sago; any one of which can be taken with 
milk, or with a little sugar without the milk. 

1139. The bowels must also be purged with small doses of 
calomel ; that is, a grain or half a grain every morning and 
evening, as the child may be older or younger, or it may affect 
the bowels. The sores themselves must be kept perfectly clean 
by frequent washing with soap and water, or milk and water. 
During this time it would be well for the child to do without a 
cap, as it keeps the parts too warm, as well as sticks to the sores 
when in contact with them. Should the child be in the habit 
of scratching the parts, mufflers should be put upon its hands. 

1 Study of Med. Am. Ed. Vol. 2d, p. 211. 



302 OF TONGUE-TIE. 

A piece of fine rag spread with simple cerate ; that is, a cerate 
composed of a little beeswax and sweet oil melted together ; or, 
what is better, fresh hog's lard, instead of the sweet oil. When 
the child is placed for sleep, let it lie as much as possible upon 
its back, that the sore may not be kept too warm. 

1140. Should the sores be very much inflamed, and very irri- 
table, a soft poultice of bread and milk should be applied, con- 
fined in fine linen rags, every four or five hours, until these 
symptoms be abated. The poulticing should not be continued 
longer than to subdue the inflammation ; for, if it be, it invites 
a great many little pustular bodies, even on the margin of the 
sound skin, which break, and increase the sore surface. There- 
fore the instant this is observed, the poultice should be laid 
aside. 

1141. After preparing the body, as well as the parts in this 
manner, which may occupy a week, or even more, according to 
the extent of surface involved, the length of time the disease 
has continued, and the degree of inflammation present, we may 
commence with the calomel ointment, (1110.) This must be 
smeared upon the external margins of the sores, as well as upon 
the sound skin itself, twice a day, taking care to wash the parts, 
as before directed, before each application of the ointment, and 
gradually encroaching upon the sores every day, by a more 
extensive application of the ointment. This remedy will rarely 
fail to destroy the farther disposition to ulceration, and pretty 
quickly alter the action of the parts, so as to make them dis- 
charge a healthy pus, instead of the ichor and sanies to which 
they have been so long accustomed. 

1142. When the parts have become healed, but covered with 
a scab, and especially if this be attended with itching, the tar 
ointment should be immediately substituted. 



CHAPTER XIV. 



OF TONGUE-TIE. 



1143. So far as we recollect, we have not met with any writer 
who has distinguished between the accidental fetter which is 
occasionally imposed upon the frsenum of the tongue, and the 
original conformation of the fraenum, which renders the tongue 
too short ; but this difference should be carefully noted, as very 
serious consequences may result from mistaking one for the 
other. We shall, therefore, notice both these conditions of the 
frsenum of the tongue. 



OF TONGUE TIE. 303 

1. Of the adventitious tying of the Tongue. 

1144. Very frequently there is attached to the frsenum of 
the tongues of new-born children, a nearly transparent, whitish 
membrane, which pursues the natural frsenum through its whole 
course, continues beyond the point where the frsenum. stops, and 
terminates near the extremity of the tongue itself; so that the 
tongue is tied down, as it were, to its proper bed. 

1145. In consequence of this disposition of the frsenum, the 
child cannot elevate the tongue or protrude it beyond the lips : 
and in its attempts to suck, it cannot supply it with sufficient 
force or certainty to the nipple, to make a complete exhaustion ; 
therefore it can suck but imperfectly; and this is accompanied 
by a clucking kind of noise. Whenever this is observed, the 
mouth should be examined, and it will almost always be found 
in the situation just described; but not necessarily, as there 
maybe clucking without this membrane; but this membrane, 
we believe, is never without the clucking. 

1146. This membrane is easily discovered by provoking the 
child to cry, or by elevating the point of the tongue by the ex- 
tremity of the little finger. In making the attempt to raise the 
tongue the child is almost sure to cry; and then this membrane 
is readily discovered, as it is now fully upon the stretch. 

1147. This defect is easily remedied. It should be done in 
the following manner : Let the child be laid across the lap of 
the nurse, with its face towards a proper light, and the operator 
stand behind the head, so that he does not intercept the light. 
The chin of the child must be gently depressed by the forefinger 
of the nurse. When the chin is thus depressed, the little finger 
of the left hand of the operator must be insinuated between the 
side of the tongue, near its tip, and the inner corresponding 
portion of the jaw, until it can lift up the point of the tongue; 
which being done, the membrane is immediately brought into 
view, and upon the stretch ; or, should the child now begin to 
cry, as it almost always does, the operator can easily place his 
finger under the tongue, and keep this false frsenum tense, while, 
by a single stroke directly across it by a sharp gum lancet, he 
divides it to the true frsenum : the operation is then finished. 
We have never known it necessary to repeat this operation. 
The incision through the membrane never yields more than a 
small drop of blood ; no hemorrhage can ensue, as this tissue 
is but very slightly vascular. 

2. Original Conformation of the Frsenum, rendering the Tongue 

too short. 

1148. In this species of " tongue-tie" the difficulty to the 
child's sucking, accompanied by the clucking noise just men- 



304 OF SWALLOWING THE TONGUE. 

tioned, arises from the frsenum proper being unusually fleshy, 
and carried too far towards the extremity of the tongue ; so 
that there is but a small portion, or distance, from the insertion 
of the frsenum, and the outer extremity, or tip of this organ. 

1149. In this case, the inconveniences to the child are pre- 
cisely of the same kind as in the other ; but not, so far as we have 
observed, to the same extent: indeed, we have occasionally seen 
Loth combined. When the fraenum proper is thus conformed, 
we never venture to do any thing; 1st, because we have never 
found it absolutely necessary; as it never so far interferes with 
sucking as to prevent it — the clucking noise, and the display of 
a little temper on the part of the child, in not receiving its nou- 
rishment as fast as it desires, are the only inconveniences attend- 
ing it ; 2dly, because, it is extremely doubtful whether the ope- 
ration has been useful ; but it is certain that it has often been 
troublesome, sometimes dangerous, and occasionally fatal. Bleed- 
ing to a fatal extent, swallowing the tongue, and convulsions, 
have followed the operation ; we, therefore, with our present 
views, can never recommend it. 

3. Swalloiving of the Tongue, and Hemorrhage. 

1150. We have often heard of, but we have never seen, a case 
of either swallowing the tongue, or of hemorrhage from cutting 
it. Dr. Underwood speaks doubtfully upon this subject: he 
says, "The occasion of this accident, it has been said, is cutting 
too deep in dividing the frsenum." I have here to notice its 
symptoms and remedy. The former are those usually attending 
strangulation, and come on suddenly, and without any probable 
cause, but that of the tongue being cut; but to which they are 
seldom attributed by those who are strangers to the complaint. 
The infant appears greatly agitated; the face turns black; and, 
unless these symptoms soon disappear, the child goes off in a 
convulsion. But if they are presently removed, the infant is 
as suddenly well; though they generally return again, and have, 
in several instances, proved fatal. 

1151. "Mons. Petit, {Mem. de V Acad, des Sciences,) has, per- 
haps, the credit of discovering the true cause of the complaint. 
The remedy consists in nothing more than bringing the tongue 
into its proper place, and, if the infant be suckled, putting it im- 
mediately to the breast will give the tongue its natural direction. 
Should the child be brought up by hand, the tongue should be 
watched for some time, at least until the bleeding be stopped; 
the complaint taking place only in consequence of that being 
considerable, so as to become an inducement to the infant to 
continue sucking at the part." 

1152. "When the sublingual veins are actually wounded, the 



OF SWALLOWING THE TONGUE. 60b 

danger, it has been said, is considerable; and it is to M. Petit 
that we are again indebted for the best contrivance for suppress- 
ing this hemorrhage. The means consist only of a piece of 
ivory, in the form of a short fork, the prongs of which should 
be so placed as to press against the apertures in the veins, and 
the other end against the inside of the lower jaw, and should, 
therefore, be broad, and somewhat convex, that it may keep its 
place." 

1153. We are sorry we cannot give any thing more satisfac- 
tory upon this subject than what we have just detailed. If it 
be true, as Dr. Underwood asserts, that swallowing the tongue 
arises only from too much blood flowing after cutting it, it must 
be of very rare occurrence. In this country we have never 
heard of an accident from cutting the tongue; and we are sure 
that none can follow, if the case be a proper one for this opera- 
tion, or if it be properly performed. 

1154. It strikes us there must be something very reprehen- 
sible, when hemorrhage to any extent occurs, either in the mode 
'of operating, or in selecting the case for it. It is generally re- 
commended to employ scissors for this purpose; to these we have 
objected for many years. We never employed them but once, 
and then found them so extremely inconvenient, that we deter- 
mined to use them no more. We substituted the common gum 
lancet, as directed above ; and we have every reason to be satis- 
fied with it for this purpose. We have already pointed out the 
kind of cases we judge proper for this operation; in such no ac- 
cident can occur, unless the most perfect mal-adroitness accom- 
pany the operation. 

1155. We have said we have never seen a case of swallowing 
the tongue; that is, we were never present to observe the phe- 
nomena such an accident would present — but we were called to 
see a child who was in the habit of doing this ; it was, however, 
relieved before we arrived. The nurse informed us the child in 
question would swallow it several times a day, if not watched. 
She always relieved it by the handle of a teaspoon pressed against 
the tongue, and drawing it forward. This child, we know, never 
had any thing done to its tongue. 

1156. In case of hemorrhage we believe filling the part be- 
neath the tongue with dry lint, and holding it there some time, 
would answer better than Mons. Petit's contrivance, provided it 
be not an artery. We have seen, within a few days, a bleeding 
from the fraenum, occasioned by a cut with a piece of tin with 
which the child had been playing : the artery, in this case, was 
taken up, by Dr. J. R. Barton, with great skill, and as much 
success. 

20 



306 OF BLEEDING FROM THE NAVEL-STRING 



CHAPTER XV. 

OF BLEEDING FROM THE NAVEL-STRING. 

1157. This accident cannot properly be called a disease ; yet 
it is of importance to understand its management when it oc- 
curs, that it may not prove injurious or fatal to the child. What- 
ever reasoning ingenuity may employ, to prove that a ligature 
upon the cord of a new-born child is unnecessary, experience 
shows it is sometimes highly useful; consequently, since, if 
properly applied it can never do harm, it should always be em- 
ployed. 

1158. Those who are well acquainted with midwifery know 
that sometimes a bleeding from this part takes place, hours after 
it has been carefully secured ; therefore, this part should occa- 
sionally be watched, lest a bleeding ensue, and weaken the child 
very much. We have never known an instance of death from 
this cause, though we have seen children very much exhausted 
by it. 

1159. This hemorrhage arises from the substance and vessels 
of the navel-string contracting so as to be no longer compressed 
by the ligature : this, however, only happens, so far as our ob- 
servations go, from two causes; namely, 1st, where the cord has 
been carelessly tied, or tied with improper substances ; in neither 
of which sufficient compression is made upon the vessels, though 
at the moment of cutting the cord they did not bleed; 2dly, 
where the cord is unusually large: in this case, it is oftentimes 
very difficult to make sufficient pressure upon the vessels, how- 
ever proper the materials of the ligature may be, or however 
well it may have been applied; for the cord shrinks in such 
cases so much as almost to leave the ligature without pressure. 

1160. We once witnessed a bleeding from the cord which had 
nearly proved fatal, where the vessels under the ligature were 
completely compressed ; therefore, there was no blame to be at- 
tached to the mode of tying, or to the substance of which the 
ligature was made. As this case was a little singular, we will 
relate it : — 

1161. We were sent for, in great haste, to see a child who 
was said to be bleeding to death. When we arrived, we found 
it extremely pale, and nearly exhausted by a bleeding from the 
cord. The child was three days old ; it had been bleeding more 
than an hour. The gentleman who had delivered the child could 
not be found at the moment he was sent for, but arrived imme- 
diately after we had got the cord exposed. 



OF ULCERATION OF THE NAVEL. 807 

1162. Upon examining its extremity, not a drop of blood was 
seen to issue from it, but a stream was observed to flow over the 
child's belly. The whole cord was now unwrapped, and the blood 
was seen to issue from the side of the cord, about an inch below 
the tying. Upon examining this part carefully, it was found 
that the vein was varicose, and had ulcerated — from this ulcera- 
tion the blood flowed. A new ligature was applied below the ulce- 
ration ; the bleeding stopped instantly, and the child recovered. 
We will not pretend to account for the blood of the child forcing 
its way into the umbilical vein after the cord had been cut; we 
only relate the fact, which suggests the following practical cau- 
tion : never to apply a ligature above a varicose portion of the 
cord, if it be possible to apply one below, lest a similar accident 
may occur. 

1163. When bleeding takes place from the extremity of the 
cord, 1st, let a second ligature be applied below the original 
one, taking great care that the second one shall not cut through 
the cord when drawn very tightly ; 2dly, that the ligature be 
drawn sufficiently tight to compress the vessels. To prevent 
the first accident happening, do not let the ligature be of thread 
hard twisted together, especially the homespun thread; and, to 
insure the second, let it be a portion of a skein of fine linen 
thread; for neither tape, bobbing, nor cotton thread, can be re- 
lied on for this purpose. 



CHAPTER XVI. 



1164. The umbilical cord separates from the umbilicus from 
the fifth to the tenth day; and though this is a process alto- 
gether of the system of the child, yet we are occasionally obliged 
to interfere, that the separation may be entire, or the healing 
perfect. 

1165. The cord sometimes remains attached by a filament for 
several days after the usual time of separation : when this is ob- 
served, it should be separated by dividing the connexion by a 
pair of scissors. This is the simplest impediment to healing : 
this process may fail by the part shooting up a kind of fungus, 
which discharges a purulent matter, and is sometimes offensive. 
This condition of the navel always excites alarm, though there 
is no positive danger; the only disadvantage is, that the part will 
not spontaneously heal, nor the discharge stop. 



308 OF HYDROCELE. 

1166. This excrescence will be found in one of three condi- 
tions: 1st, the navel may exhibit an elevated ulceration of its 
whole surface ; 2dly, it may form a kind of button, with narrow 
base or pedicle; 3dly, this button may have a broad base; each 
of which will require a little difference in management. 

Treatment in the First Situation. 

1167. This condition of the navel will be readily healed by 
sprinkling it with white lead, or finely powdered Aleppo galls, 
or calomel. All these substances act as escharotics ; when any one 
is applied, the surface immediately below becomes killed ; there- 
fore, time must be given for the sloughs to come off. When it 
separates itself, a fresh portion must be applied, and so on until 
the part is entirely healed. 

Treatment in the Second Situation. 

1168. A dark red tumour may be discovered within the cavity, 
formed by the retiring of the navel; this, when pressed out, will 
have a foot- stalk, and much resembles a cherry attached to its 
stem. All that is necessary here is to pass a ligature round it, 
and sufficiently tightened. It will soon drop off, and occasion 
no pain. It sometimes may not immediately heal after the re- 
moval of the top, as the remaining portion may again shoot up 
a new product — if this happen, the remedies named for the first 
condition will quickly relieve it. 

Treatment in the Third Situation. 

1169. For this condition, a ligature cannot be applied, as its 
base is broad — we are, therefore, obliged to depend upon escha- 
rotics, as in the first case. It, however, will not always yield to 
the already suggested remedies : when this is the case, we have 
been a few times obliged to have recourse to a pretty strong 
solution of the nitrate of silver; this must be applied by means 
of a camel hair pencil, and repeated until the part heals. We 
have never known this application give pain, unless it were too 
liberally used, and made to act upon the sound skin, 



CHAPTER XVIL 

OF HYDROCELE. 

1170. This affection of the scrotum resembles that of adults 5 
most probably, in many cases, the child is born with it ; it. is 



OF UMBILICAL HERNIA. 309 

however, not generally noticed until four or five days, and some- 
times even longer, after birth. It always excites a good deal of 
alarm ; and it is proper it should, as it always deserves attention ; 
not so much for itself, since it is of easy management, as because 
a rupture at the part resembles it. 

1171. It may be distinguished from hernia by its equal dis- 
tention; by its transparency; by not being increased by the cry- 
ing of the infant; its want of sensibility on handling it, and 
by not retiring by pressure. So far as "we have seen, the water 
is confined to one side of the scrotum ; it may, however, be oc- 
casionally in both. We have several times seen the tumour as 
large as a small hen's egg. This complaint is not always con- 
nate; we have seen it occur several months after birth; and, in 
one case, several years. It is never productive of inconvenience 
to the child, yet it demands attention. 

1172. It has always yielded to the' t application of cold water, 
though we have occasionally found it obstinate. This is espe- 
cially the case, perhaps, when it does not take place for a long 
time after birth — at least, it was so in an instance in which this 
disease did not appear until after the child was three years old. 
In this case, the water was steadily applied morning and evening 
for several weeks, without any apparent amendment. The child 
was now confined to a milk and vegetable diet; and took daily, 
or every other day, ten grains of cream of tartar, and six of jalap. 
In this way he was purged pretty freely for a fortnight ; the 
water was, however, continued during the whole of this time, and 
in a fortnight more the whole tumour disappeared; nor has the 
child had any return. 

1173. The best mode, we believe, to use the water, is to pour 
it from a height, pleno rivo, upon the part. Two quarts, at least, 
of water should thus be let fall, morning and evening, through 
the spout of a tea-kettle. 



CHAPTER XVIII. 

OF UMBILICAL HERXIA. 

1174. "We have adverted to the cause of hernia in several 
places, but particularly in Book I. p. 72, under the head of 
Belly-band: as well as at p. 227, under the head of Exercise. 
When treating of the application of the belly-band, Ave gave it 
as our opinion that the too tight application of this bandage 
was no unfrequent cause of this complaint, when, from the con- 
formation of the parts, there was a disposition to it. We then 
suggested some cautions, to which we must beg leave to refer. 



310 OF THE INGUINAL HERNIA. 

1175. It may be proper to observe that the nurse is always 
blamed when this accident happens, but not with sufficient rea- 
son; for we do not believe it to be in her power always, nay, we 
may say it is very rarely so, to prevent it, for, in general, it is 
owing to a natural defect of the part. Yet a prudent care is 
essential to the good health of the child. It must be remarked, 
that children who cry a great deal, and who have had very large 
umbilical cords, are more subject to it than others. 

1176. It would be well for the nurse to examine this part from 
time to time after the separation of the cord, especially while the 
child is crying. Should she discover any pouting out at this part, 
she should immediately inform the parents of the circumstance, 
and not reprehensibly conceal it, from a fear she may be blamed 
for the accident. 

1177. Much important time is sometimes lost by this conceal- 
ment; yet it is expecting rather too much moral courage in the 
nurse to discover it, as she is sure to call the blame upon herself 
by her candour. On this account it is every way important to 
be understood how seldom and how little agency the nurse has 
in its production. It is but justice to that class of people to de- 
clare the truth upon this point. 

1178. As soon as this disease is discovered, it would be well 
to attempt to remedy it; 1st, because we are persuaded the best 
chance of a cure is when it is taken as early as possible, that the 
passage for the gut may not be confirmed by the frequent ap- 
pearance of this part in the opening, which will be sure to be 
the case whenever the child cries, coughs, sneezes, or even goes 
to stool, if the part be not protected by a counter pressure: — 
2dly, because at this early period there is a natural disposition 
in the hole through which the gut is forced to obliterate itself. 

1179. Dr. Underwood, and others, recommended, at first, com- 
pression by straps of adhesive plaster : this plan has not always 
succeeded with us, though it sometimes does. But we never fail 
to cure it by the application of Dr. Hull's umbilical truss. This 
is simple in its construction, correct in its principles, and gives 
but very little trouble in its action. 



CHAPTER XIX. 



OF THE INGUINAL HERNIA. 



1180. This complaint is not so frequent as the umbilical, but, 
generally speaking, it is of more difficult management, and of 
more serious consequence. This complaint consists of a descent 



OF ABSCESS OF THE HIP JOINT. 311 

of a portion of intestine or omentum, into the scrotum : it may 
exist before birth, or may take place soon after. 

1181. This complaint may be suspected whenever the scrotum, 
especially on one side, is more than usually large ; and it may be 
detected by the tumour being removed by pressure, and by the 
testicle not being discoverable. This disease may, however, take 
place at any period of life, but especially during its most active 
stages. 

1182. Dr. Underwood says: "The bubonocele may be safely 
left without a bandage, especially as the cold bath alone gene- 
rally cures it, when happening to children before they go alone." 
We are always sorry when we are obliged to differ with this re- 
spectable author ; and the complaint under consideration is one 
of the instances in which we are obliged to oppose the experience 
of the late Dr. Physick, as well as our own, to what he has ad- 
vanced in the quotation just mentioned. 

1183. The late Dr. Physick advises, without reserve, the ap- 
plication of a properly constructed truss to the part, whenever 
the disease maybe discovered; and considers it unsafe to permit 
the child to do without one : especially as the disease, if it be 
properly managed by a well adjusted truss, is permanently cured ; 
but if it be permitted to continue without such application, it may 
become strangulated, or the disposition of the hole through which 
the gut descends, to contract, is lost, and thus the child ever 
continues to suffer under this complaint. 

1184. We would, therefore, advise, in conformity with an ex- 
perience at once so extensive and valuable as that of Dr. Physick, 
that recourse be immediately had to the only certain remedy. 
In using a truss, however, for this purpose, much care is required ; 
1st, that the machine be properly constructed for the end pro- 
posed; and, 2dly, that it be properly adjusted to the parts, that 
the end may be insured ; 3dly, that the protruded parts be care- 
fully replaced before it is applied; 4thly, that it be worn day and 
night. 



CHAPTER XX. 

ABSCESS OF THE HIP JOINT. 

1185. The commencement of inflammation in the hip joint is 
not perceived as early as would be useful to the patient ; or, if 
some alteration in the health and vigour of a limb be observed, 
it is not always attended to sufficiently early. This complaint 
is most frequent with children ; the variety of little injuries which 



312 OF ABSCESS OF THE HIP JOINT. 

they must almost necessarily sustain in the exercise of their 
juvenile sports, misleads, very often, even anxious and watchful 
parents, when any slight complaint is made of pain, uneasiness, 
stiffness, or even diminished ability to walk; since they are all 
in their turns attributed to a bruise, a fall, or a wrench, which 
they suppose will quickly pass away by rest. 

1186. Even after the disease has progressed some time, and 
an evident weakness is observed in the limb, by its being fa- 
voured at the expense of the other ; when pain is felt from mo- 
tion, and there is a disposition to fall from slighter causes than 
usual ; and even when the points of the toes look more inward 
or outward than natural; the true nature of this disease is not 
suspected, as there is no fixed pain in the hip joint, or even upon 
pretty hard pressure — indeed, the friends of the patient are con- 
stantly misled by his declaring he feels no pain except in the 
knee. 

1187. If the two limbs be compared, even before the disease 
has proceeded far, the diseased one will be found rather longer 
than the other. After awhile the natural convexity of the hip 
is lost ; and when the patient walks, it is found that the greater 
part of the weight of the body is sustained by the sound limb, 
and a limping commences. Though the patient locates his in- 
convenience in the knee, because he there alone very often feels 
the pain, yet this part will bear pressure and motion without 
experiencing the least inconvenience; but not so always, the hip 
joint; for if the sensations of the patient be carefully examined 
during the motions imposed upon the knee joint, such as bend- 
ing it, and straightening of it, it will be found he experiences 
inconvenience in the joint of the hip. 

1188. This is the commencement of inflammation of the hip 
joint ; and, if it be not controlled in due time, it runs on to sup- 
puration. An abscess forms, which opens and gives issue to an 
unhealthy pus; the bones at the bottom of the abscess but too 
frequently become carious ; hectic fever ensues ; and after suffer- 
ing, of a longer or shorter duration, the patient dies, exhausted 
by discharges and sufferings. 

1189. For remedies to be useful in this disease, they should 
be early applied, regularly persevered in, and the most perfect 
rest enjoined upon the patient: with such treatment, the disease 
may frequently be cured; but if the disease have been neglected 
in its early stage, the remedies but partially administered, and 
the patient permitted to use exercise, the disease then becomes 
as painful as hopeless. 

1190. The cure must be attempted by bleeding, leeching, cup- 
ping, purging, low diet and rest. We have seen three instances 
of entire restoration where this plan was completely tried; and 
we have witnessed more than twice that number terminate in 



OF ABSCESS OF THE HIP JOINT. 313 

incurable lameness; fistulous openings, with never-ceasing dis- 
charges of ill-digested pus, and death from hectic, will follow. 

1191. From pain being seated in the knee, this complaint 
is always mistaken for rheumatism, or some other local affection 
of this part ; and to it are all the remedial powers addressed — 
we need not say how unavailingly. 

1192. To Dr. Physick we are indebted for the proper mode 
of treating this affection ; and to his happy genius are hundreds 
under obligation, who have suffered from it, for the preservation 
of their limbs, and for the enjoyment of life. It was he who 
first suggested constant purging, and entire rest; and to which 
this formidable disease so often yields, when tried under proper 
circumstances. Valuable as this plan is, it must be confessed 
to be one of difficult execution; but we know, from experience, 
it is not impracticable; and, from the same experience, we know 
it to be successful. Who, then, would hesitate to enforce a plan 
that might save a lovely female from an incurable lameness, or 
a favourite son from a lingering death? 

1193. But let us be a little more particular in developing the 
plan just spoken of. The child must abstain from all animal 
food or broths ; he must be laid prostrate upon his bed or mattress, 
and this without exercising the limb but as little as possible: he 
must be bled freely from the arm, if the pulse be active, or 
leeched upon the hip, if the bleeding be not indicated: these 
must be repeated in proportion to pain, or fever, if either come 
on. The bowels must be purged daily, or every other day, by 
the exhibition of cream of tartar and jalap, in doses suited to the 
age of the patient, and this persevered in until amendment is ob- 
vious or the cure completed. Under this apparently weakening 
plan, it is astonishing, sometimes, to see how health and strength 
improve. Where it is impossible to confine the patient, much 
advantage is found from the curved splint, made to fit the hip 
and thigh. The ingenious Mr. William Rush, (ship carver,) is 
very successful in adapting the splint to the shape of the parts 
concerned. To show how easily and commonly this case is mis- 
taken for rheumatism, we will relate one case of several of a 
similar kind. In June, 1823, we were requested to visit Miss 

, aged fourteen; she was from the country; she was there 

treated for a rheumatism in the knee, by stimulating and other 
applications for some time. At the request of a relation residing 
in the city, she was brought down for farther advice. We soon 
discovered the complaint to be a hip disease ; and we wrote a 
letter of instructions for its treatment. After our taking leave, 
it was agreed she should remain in town to put the proposed 
plan in execution, and she, accordingly, commenced forthwith, 
and this with as much perseverance as success. She was bled 
and leeched twice, purged every day, or every other day, at far- 



314 ABSCESS WITHIN THE EAR. 

thest, with jalap and cream of tartar ; confined closely to her bed ; 
and observed the most abstemious diet, for two months ; at the 
end of which time we had the pleasure to return her to her 
anxious parent perfectly restored; and up to this time she remains 
well. But every case is not so quickly relieved. Dr. Physick 
and myself had a very desperate case lately, which required 
six or seven months to cure; 1 but which was in this time happily 
effected. The splint was modelled to the shape of the leg, three 
times, as it required lengthening during the progress of the cure. 



CHAPTER XXI. 



ABSCESS WITHIN THE EAR. 



1194. Children, after they are six months old, are sometimes 
found to cry violently, and toss their little heads from side to 
side, expressing thereby the greatest agony. Not being able to 
point out the seat of pain, it is variously located by the parent 
or by the practitioner. It will sometimes stop crying very sud- 
denly, and fall into a sound sleep, from which it will be roused 
by renewed torture. This pain is not generally attended by 
any disturbance of the system : fever seldom attends, but when it 
does it is sometimes very high, and even attended by delirium. 
It is generally mistaken for colic, or belly-ache. 

1195. It may, however, readily be distinguished from this af- 
fection by its not being accompanied by drawing up of the legs 
and thighs ; by no flatus rumbling in the bowels, and by the 
hands and feet not being cold, or by the pain not being relieved 
by remedies addressed to these parts. We have always reason 
to suspect this pain to arise from an abscess forming in the ear, 
when the child throws its head backward and forward, and in- 
deed in all directions, during the paroxysms of pain; when it is 
found to lie on one side easier than the other ; when laudanum 
procures but temporary relief; and when, upon pressing the ear 
with the point of the finger placed against the lower portion of 
the external meatus, it complains ; and above all, when the ab- 
scess can be discovered by looking into the ear; this, however, 
but seldom happens. 

1196. We have witnessed this affection so frequently, and have 

1 That is, the inflammation of the joint was subdued, and the threatening symp- 
toms had ceased. But as the limb was very much contracted, it required the con- 
stant application of the splint for a number of months more before it became 
straight. This young lady now walks without much difficulty, though the disease 
was for a long time a very serious one. 



OF ABSCESS WITHIN THE EAR. 315 

been so often alarmed by it, that we always apply remedies to 
the ears, when we have satisfied ourselves the pain is not in the 
bowels, by the absence of the symptoms noticed above, nor in 
the head itself, by the absence of all fever, or derangement of 
the stomach. 

1197. When we suspect the ear to be in fault, and have been 
called to the child in the commencement of pain, we almost in- 
variably order a few leeches to be applied under that ear of which 
the child complains, if pressed, as above directed. We also direct 
a little laudanum on lint pressed gently into the ear, and this 
repeated as occasion may require. Should these fail to afford 
relief, we advise a blister to be applied immediately under the 
ear, and purge the child pretty briskly. 

1198. This plan sometimes succeeds to admiration, and we 
believe it would oftener do so, were the remedies applied suffi- 
ciently early : but unfortunately the time for useful exertion is 
almost always lost by a trial of temporizing applications ; and 
we have but too often the mortification to witness only the dis- 
charge from the ear. When the ear discharges, the little pa- 
tient is immediately relieved: it falls into a sound sleep, and 
forgets all its sufferings, until again it is obliged to go through 
the process a second, and even a third time, in the period of 
two or three months. 

1199. Sometimes the abscess heals without the smallest trou- 
ble, leaving the ear free from discharge in the course of a few 
days ; but at other times the mischief done the inner cavity of 
the ear is serious and permanent. The small bones of the ear 
become detached by suppuration, and are discharged with the 
pus which constantly flows from the external orifice of this or- 
gan. The discharge generally becomes very offensive, both 
from the matter being confined, as well as from the caries under 
which the bones are labouring. When caries take place, the 
case is almost hopeless; and must, in a great measure, be aban- 
doned to nature, only paying attention to cleanliness. It also 
happens that the inflammation of the fibro-mucous membrane of 
the tympanal cavity travels backwards to the mastoid cells, and 
even proceeds towards the brain itself, through the fenestra ovalis, 
and fenestra rotunda in the vestibule, and the cochlea respec- 
tively ; and may thus be transmitted to that portion of the dura 
mater which covers the petrous portion of the temporal bone — 
and hence we may have delirium, suppuration, exfoliations and 
death. 

1200. It is a matter of primary importance to keep the parts 
clean by frequently washing out the canal of the ear, first with 
fine soap and warm water, followed by equal parts of lime-water 
and milk, and a small portion of the tincture of myrrh. Our 
formula, for this purpose, is as follows : 



316 OF ADHESION OF THE LABIA PUD END I. 

Of lime-water and milk, each two teaspoonfuls; 
Tincture of myrrh, twenty drops. Mix. 

1201. This mixture should be prepared only as it may be 
wanted, and thrown into the ear four or five times a day. At 
night, the child should be made to lie upon the affected side, 
that the matter may discharge freely. 

1202. This discharge from the ear is always attended by dul- 
ness of hearing; on this account, it were desirable it should be 
relieved as quickly as possible, lest its continuance do irreparable 
mischief to this organ. The mixture of lime-water and milk, 
when no serious injury has been done to the bones of the ear, 
will, if properly persisted in, very often succeed; and we are 
informed, by a late writer on this affection, that a solution of 
the nitrate of silver will be found a most valuable application. 

1203. We think we have seen advantage from the little pa- 
tient wearing a plaster spread with Burgundy pitch, or shoe- 
maker's wax, under the affected ear. And we once witnessed a 
case of years' standing yield to an issue in the arm of the side 
affected. This was kept discharging for a year: it was then 
suffered to heal, which it did without any subsequent disadvan- 
tage. 



CHAPTER XXII. 

OF ADHESION OF THE LABIA PUDENDI OF CHILDREN. 

1204. The labia pudendi of young children are very often 
found adherent. This may be congenite, but we believe it is 
•very rarely so. We have seldom seen this condition of the parts 
in children under six months old, and still more rarely after 
the age of a year. From these facts, it would seem to be almost 
always adventitious, and owing principally to a want of cleanli- 
ness. Had the child been born with labia in this condition, 
it is more than probable it would have been discovered early, as 
nurses, generally speaking, are at least curious, if not always 
careful, in their examinations. 

1205. When we consider the delicacy and vascularity of the 
membrane lining the internal face of the labia; the ease with 
which inflammation may be provoked, in parts so organized; 
when we recollect how quickly the secretions of the parts become 
acrid, where proper attention is not bestowed upon them; and 
how easily a slight inflammation may be increased, by the fre- 
quent flow of urine; we shall cease to wonder at the frequency 
of this complaint, and, perhaps, only be surprised that it does 
not more frequently occur. 



OP ADHESION OF THE LABIA PUDEKDL 317 

1206. We have reason to believe, in many instances, this 
complaint had existed some time before it was discovered; this 
may especially be the case with fat or lusty children, and where 
the most scrupulous attention is not paid to the condition of 
these parts. Therefore, it must be looked upon, in general, as 
a most reprehensible piece of neglect; for it is the bounden duty 
of every mother, however averse she may be to its perform- 
ance, to carefully inspect these parts from time to time, particu- 
larly until the child is fifteen or eighteen months old, in order 
that the inconvenience under consideration may not take place, 

1207. Parents should direct, and the performance should be 
insisted on from nurses, that these parts should be regularly 
cleansed every time the child is washed, by separating the labia 
and applying water to them liberally ; they should then be ten- 
derly dried with a soft linen cloth, and dusted with hair powder, 
or powdered starch, in which there is no indigo. If this were 
regularly done in early infancy, the parts would become so 
hardened as very much to diminish the risk of this accident 
taking place. 

1208. We have dwelt upon this subject because we know its 
importance; and because it has not sufficiently attracted the at- 
tention of parents. Unfortunately for the female, sometimes it 
has not been discovered during infancy; and it is especially so, 
when it remains concealed until womanhood, when, perhaps, the 
first intimation she may receive of her situation is at a time 
when of all others she would wish to have been ignorant of it. 
The alternative, now, subjects her to an operation which should 
have been performed in early life; and by which all the finer 
feelings are excruciated with a severity that can be better con- 
ceived than described. 

1209. This complaint sometimes becomes relieved spon- 
taneously, but not always happily; and this may occur more 
frequently than we are aware of; since the causes which may 
produce it are too constantly operating not to lead us to suppose 
this accident to occur in cases where it may not be detected. 
We had two instances of this spontaneous change to happen 
under our own observation. 

1210. In one of these cases, there was so much inflammation 
and tenderness in the parts, that we did not think it advisable 
to operate, until the existing state of things was changed. We 
directed soft bread and milk poultices, and a cathartic. On our 
next examination, a complete separation had taken place, by the 
adhering parts having suppurated, and exposing two raw sur- 
faces, which required much attention to prevent reunion by their 
healing. 

1211. The other case was something similar; suppuration 
had commenced, and the connecting medium was nearly de- 



318 OF THE DIABETES OF CHILDREN. 

stroyed, when it was first observed. It was poulticed, as in the 
other case ; and when about to heal, care was taken to prevent 
a second coalescence of the parts. 

1212. This condition of the labia is easily detected by their 
refusing to be separated. When the parts are distended as much 
as their condition will permit, a continuous line of adhesion will 
be observed through the whole tract of the labia, as far as the 
meatus urinarius ; of course, the os externum of the vagina is 
entirely concealed. The child passes its water without much 
difficulty; and when the complaint has been suffered to run on, 
or is not discovered until womanhood, the menstruous fluid has 
been evacuated through the same external aperture by which 
the urine was discharged. 

1213. There is but one remedy, that we know of, for this 
complaint — and that is, to divide the parts. This is very easily 
performed, by passing a probe-pointed bistoury into the orifice 
immediately before the meatus urinarius, and cutting downward 
into the inferior junction of the labia. A small dossil of lint 
moistened with sweet oil, may be insinuated between the sepa- 
rated portions. The wounds heal without the smallest difficulty 
in two or three days. Dr. Denman recommends, for the removal 
of these adhesions, that the labia be forcibly separated, so that 
they may be destroyed. We look upon this method as much 
more painful than the knife, and certainly not more efficacious. 
See Diseases of Females, by the Author, p. 30. 



CHAPTER XXIII. 



OF THE DIABETES OF CHILDREN. 



1214. This complaint was first noticed by Morton, agreeably 
to Dr. Underwood : he considered it altogether a sympathetic af- 
fection, and we believe correctly-— at least, the three cases which 
we have witnessed happened to children who were teething. 
It should not surprise us more, that the kidneys hold inter- 
communion with the gums, during teething, than that the 
neck of the bladder should; and of this we see frequent in- 
stances. 

1215. Morton speaks of this disease as a family complaint; 
having proved fatal to all the male children, with the exception 
of the last, which was under his care, and appeared to be relieved 
by the plan he adopted — namely, confining the child entirely to 
a milk diet ; and to allay the excessive thirst, he allowed only 



OF IX CONTINENCE OF URINE. 319 

milk, mixed with a chalybeate water. The diabetic symptoms 
in this case were wont to return with every tooth that was about 
to pierce the gums. 

1216. This complaint consists in the immoderate discharge of 
urine, attended with great thirst and emaciation. In Morton's 
case, the urine was as sweet as that of adults labouring under this 
complaint. In those we witnessed, we regret to say, we could 
not procure the urine to make trial; and, therefore, cannot tell 
whether it was sweet or not. All the children we have seen with 
this complaint were under fifteen months old ; and, though 
teething, yet, from a careful examination of the mouth, we could 
not, in either of these cases, find teeth immediately protruding 
the gums. 

1217. The quantity of urine discharged was very great; and 
this at very many times ; the children fell away rapidly, and 
weakened very fast. We ordered the bowels to be kept freely 
open, and a quantity of the spirit of turpentine to be kept upon 
the clothes of the children, so as to keep them in a terebinthinate 
atmosphere. This plan succeeded completely in every case. 



CHAPTER XXIV. 



OF INCONTINENCE OF URINE. 



1218. This is more frequently a disease of habit, than of any 
derangement of the sphincter of the bladder, or a symptom of 
stone, or calculi; yet it may occasionally proceed from either. 

1219. If this complaint arise from the presence of a stone 
in the bladder, it is evident that nothing but the removal of it 
can effect a cure: if from a lithic disposition in the urine, it 
maybe sometimes improved by repeated doses of magnesia; 
soda, supersaturated with carbonic acid gas; lime-water and 
milk ; a few drops, three or four times a day, of the spirit of 
turpentine, or of balsam copaiva, &c. 

1220. But when it is purely the effect of habit, as it most 
frequently is, nothing but the destruction of the habit can afford 
relief. This may be done, 1st, as directed very properly by 
Dr. Underwood, by taking the child from its bed, after it has 
been there awhile, and obliging it to remain on the pot until it 
discharge its urine; having previously, however, seen that it 
had emptied its bladder before it went to bed. Or secondly, by 
such remedies a3 appear to alter the condition of the neck of 
the bladder; rendering it less susceptible to the irritation of the 
urine, and by instituting new associations; by creating new 



320 OF CONSTIPATION. 

sensations, or susceptibilities in it; as by the tincture of can- 
tharides, in doses of ten or twelve drops, three or four times a 
day, in a little sweetened water; gradually increasing the dose 
two or three drops at a dose, until heat is perceived in making 
water; it must then be desisted from; and, should strangury 
ensue, let it be quieted by drinking freely of flaxseed tea, gum 
Arabic water, or any other demulcent — if severe, by three or 
four grains of camphor, and a few drops of laudanum, or the 
warm bath. Mr. Lair proposes the introduction of the tincture 
of cantharides into the urethra by means of a catheter, so as to 
apply to its prostatic part. By this means, he declares, he 
cured three patients of incontinence of urine. — Med. Chirur. 
Rev. for January, 1827, p. 244. 

1221. Blisters applied to the sacrum we have found highly 
beneficial; or even plasters of Burgundy pitch, upon the same 
part. A most interesting case of this kind fell lately under our 
care, which it may be useful to relate. A delicate boy, eleven 
years of age, was severely afflicted with this weakness, from an 
early period of his life. Every precaution likely to interrupt 
the habit was unavailingly had recourse to. During the day, 
he was constantly running to discharge his bladder, so that he 
was obliged to neglect even his education; and, at night, it 
seemed to pour from him in almost a continuous stream. These 
discharges were attended by severe suffering at the neck of the 
bladder, so much so, that it led us to suspect there might be a 
stone in the bladder ; and we begged that our friend, Dr. Phy- 
sick, might examine him — this was done, and no stone was found. 
The poor boy suffered considerably in the passing of the sound : 
the parts became a little inflamed, and his urine suppressed. 
By the use of neutral salts, laudanum, and the warm bath, he 
was pretty soon relieved of the suppression ; and with it passed 
away almost entirely his inability to retain his water. The black 
drop was ordered him at night, with the most manifest advantage 
— this he continued for a long time. We were unwilling to 
interrupt the use of this medicine, until convinced that the irri- 
tability of the bladder was destroyed — this took place in a few 
months after. 



CHAPTER XXV. 



OF CONSTIPATION. 



1222. Tardy bowels may be either accidental or constitu- 
tional : if the former, it is always well to inquire into the cause, 



OF CONSTIPATION. 321 

that it may be removed as quickly as possible. The bowels of 
infants may become costive, from improper food, or food which, 
in itself, may be proper in some constitutions, yet may produce 
costiveness in others. Thus, we find rice, in all its preparations, 
will sometimes make the bowels of some children tardy: when 
this is found to be the case, it should not be employed under 
any pretext. Again, boiled milk will have this tendency occa- 
sionally, and so many other substances, all of which should be 
laid aside the instant they are known to produce this effect. 

1223. But there is a cause of accidental costiveness that is 
not generally known, which is much more injurious than that 
from any other — namely, from laudanum. Nurses are now so 
familiar with this drug, that it is as regularly carried about them 
as their scissors or thimble, and is much more indispensable to 
their comfort than either of these emblems of industry. If the 
child do not go to sleep, or it be even feared it will not, at the 
exact moment which will suit the arrangements of the nurse ; or 
if it cry from any cause, so as to give any additional trouble, 
laudanum is given to make "assurance doubly sure." 

1224. The consequence is, that an accidental is converted into 
an habitual costiveness; or the child may fall a sacrifice to con- 
vulsions, or other fatal diseases, before the disposition of the 
bowels may be changed. In all instances of accidental costive- 
ness, the child should be watched; and, if the bowels do not 
seem inclined to relieve themselves, they should be aided by 
artificial means, and that very promptly, if the slightest indis- 
position should manifest itself at this period. 

1225. The most prompt application for this purpose is an 
injection, or even a suppository. 1 The former may consist of 
a rich solution of molasses, in a gill, or even less of warm water, 
to which may be added a pinch of common salt ; the other may 
consist of a piece of the common brown or rosin soap, an inch 
in length, and one-fourth of an inch thick, shaped round, and 
slightly tapering to a point. This must be dipped first in water, 
and then passed into the rectum, and pressed by the point of 
the finger beyond the sphincter ani. Either of these means will 
almost always procure the desired evacuation; and may be made 
always most safely, and very often most advantageously to an- 
ticipate the operation of other medicine. 

1226. The most proper cathartic medicine for children is 
castor oil, or magnesia. The quantity of either must be pro- 
portionate to the age and habit of the child — from a tea-spoonful 
to a table-spoonful of oil will be a dose for children from a 

1 It may be proper to observe, that in employing a suppository, care should be 
taken that it be removed, either by a second application, or by an injection, when 
it does not speedily produce its effect; and especially if it excite an unsuccessful 
effort to discharge itself. 

21 



322 OF CONSTIPATION. 

month to two or three years old. Of magnesia, from one to 
two large tea-spoonsful will be doses for the same ages. The 
castor oil should always be given warm and alone ; the magnesia 
should be most intimately mixed with a little sweetened milk. 
Manna may also be used as sweetening for the child's food — it 
may require from a quarter to half an ounce for a dose. 

1227. When it is desirable to alter the costive condition of the 
bowels as a habit, it is always better to do it by diet than by 
medicine. Molasses, freely used, is excellent for this purpose : 
but the best remedy we have yet met with is a mush made by 
boiling a small quantity at a time of the unbolted wheat flour in 
water, and straining it through a sieve while hot. It will be 
perceived this must be made thin. A portion of this must be 
used in the milk the child takes ; or it may be fed with it, a 
little sweetened, two or three times a-day, or oftener, or more 
seldom, as the case may require. When this is properly attended 
to, we have never seen it fail. 

1228. But should this costiveness appear to have provoked 
fever, induced pain, or excited convulsions, more active medi- 
cines, as jalap, or calomel and jalap, may be used; or the others, 
namely, castor oil or magnesia, may be repeated every hour or 
two, until the effect be produced. 

1229. Constitutional costiveness, not attended by any de- 
rangement of the system, rarely requires an interference. Dr. 
Underwood asserts that the condition of the child's bowels keeps 
pace with those of the mother : this is certainly very far from 
being always the case. We have known the child very costive, 
while the mother was not so, and the reverse. This slow motion 
of the bowels may be from two days to ten, without the child 
receiving the least injury from this torpor. 

1230. We were once consulted for a child of six months old, 
on account of its excessive costiveness ; it had an evacuation but 
once in eight or ten days, but was perfectly healthy ; throve 
well, and in every respect might be said to be in excellent health. 
We advised 'that nothing should be done, as long as the child 
was free from complaint. What added to the peculiarity of this 
case was, the relaxed condition of the mother's bowels ; she was 
subject to a kind of diarrhoea the whole time of her suckling. 
The child in question never required any medicine ; when it 
began to cut its teeth pretty rapidly, its bowels became less 
confined, but was never free in them, until after weaning. 



OF IDIOPATHIC VOMITING. 323 



CHAPTER XXVI. 

OP VOMITING. 

1231. Vomiting, -with young children, is very far from always 
being a disease. This fact should be well remembered by young 
and inexperienced mothers, who are apt to become alarmed by 
incidents which sometimes only prove the healthfulness of their 
children. Of this kind, very often, is the vomiting about to be 
considered, which, if treated as a disease by an incautious prac- 
titioner, may really be converted into one ; whereas, if nature 
be permitted to have the management, she will secure the health 
of the child. 

1232. But it will be asked, are we never to interfere with 
vomiting ? — and, if we are, how shall we know when this inter- 
ference may be proper, or when it would be best to let it alone? 
To answer these questions, it will be necessary to divide this 
act into the idiopathic, or spontaneous, and sympathetic, or pro- 
voked. 

1233. By the first we are to understand that effort of the 
stomach, which it almost invariably makes to throw off whatever 
may be offensive to it, from its bulk rather than from its quality, 
but in which the system at large has no participation. By the 
second we mean, 1st, that condition which arises from its con- 
nexion with other parts of the body, which, when in a state of 
disease, through the medium of that power called sympathy, be- 
comes irritated to vomiting; or, 2dly, by the presence of some 
acrid, deleterious, or undigested substance within its own cavity, 
exciting it to this act; and, 3dly, when its powers are deranged, 
and, consequently, its functions are not carried on in a healthful 
manner. 

Sect. I. — Of Idiopathic vomiting. 

1234. Under this distinction we must consider the throwing 
off the contents of the stomach in young children, and especially 
those at the breast, when this organ has been compelled to re- 
ceive too much; the dentition becomes a source of irritation, and 
the act of vomiting, (or rather of regurgitation, for it is scarcely 
an effort,) is produced. Hence, we see children who have been 
liberally supplied at the breast, often throw up the greater part 
of what it had just before received. But this act must not be 
considered a diseased condition of the stomach, or one meriting 
medical attention. We, therefore, never interfere with such cases 
so long as the child thrives, or the powers of this organ are not 
deranged. 



324: OF SYMPATHETIC VOMITING. 

1235. When this kind of vomiting takes place, it is almost 
immediately after the child has sucked; the milk comes up 
pure arid unchanged; it is discharged without any seeming ef- 
fort, or nausea; and the moment it is removed from the breast, 
is cheerful, and, apparently, happy; nay, it very often happens 
in the midst of some expression of its healthfulness and happi- 
ness, and this sometimes without altering the expression of cheer- 
fulness. Now, were this vomiting to be looked upon as injurious, 
and treated as a disease, the evil intended to be removed, would 
really be created or increased. 

1236. Though we do not consider this an unhealthy act, it is 
not, or rather should not be made a necessary one of the sto- 
mach: for it almost always proceeds from repletion, or from this 
organ being disturbed by some rude handling of the child. To 
prevent its taking place from the first cause, the child should be 
taken from the breast the moment it begins to dally with it; or 
when it ceases to draw as if it were really gratifying a necessary 
and proper appetite. If this be done, and the child suffered to 
remain for awhile perfectly quiet after its removal from the 
breast, this inconvenience, (for such it is,) will certainly cease. 
But the too common practice of jolting and tossing the child, 
(see Book I., p. 156, par. 575,) immediately after nursing, will 
be sure to derange its stomach, and vomiting will ensue — there- 
fore, this barbarous custom should be instantly forbidden. 

1237. There is an error very commonly committed with 
children who throw up frequently, which is to apply them to the 
breast immediately after they have discharged their little sto- 
machs, under the pretence of "making up for what the poor 
little thing has lost ; " and thus this evil is perpetuated; whereas, 
to manage this case properly, the stomach should be allowed to 
rest awhile. 

Sect. II. — Of Sympathetic Vomiting. 

1238. 1. This act of the stomach may take place from affec- 
tions remotely situated from it, as in certain fevers; affections 
of the kidneys, the head, the neck of the bladder, &c, through 
the medium of the nervous system. But in all such cases the 
stomach cannot very often be quieted except by the removal of 
the original complaint. Dr. Underwood says it may arise from 
"a suppression of the" discharge behind the ears, and, more 
especially, if consequent upon the use of drying remedies," or, 
from "the sudden disappearance of some eruption on the skin." 

1239. We have never witnessed vomiting from either of the 
last two named causes; and we more than suspect that too much 
has been taken for granted, " unless it be where drying applica- 
tions" have improperly been made: in this case, we can readily 
believe that injury might follow such an imprudent practice; but 



OF SYMPATHETIC VOMITING. 325 

where the discharge from behind the ears, or the disappearance 
of an eruption from the skin, has suddenly taken place, it would 
be right to inquire, what gave rise to the suppression of a dis- 
charge in the one case, or to the retrocession of an eruption in 
the other? for the cause capable of producing such effects might 
also produce the vomiting in question. 

1240. The management, then, of vomitings of this kind, con- 
sists, almost exclusively, in the treatment of the original disease 
which produced it. It is true we occasionally succeed in miti- 
gating this affection by remedies exclusively addressed to the 
stomach, but not often ; unless it be when the original disease 
itself is yielding to treatment instituted for it. Then a little lime- 
water and milk, soda water, or injections with laudanum, will 
sometimes succeed. For young children, that is. under a year, 
a tea-spoonful of lime-water and as much milk, given once an 
hour, will generally be sufficient ; half a wine-glassful of soda 
water, from time to time, may be given at once ; or an injection 
of a table-spoonful of warm water, and eight or ten drops of 
laudanum, may be administered. If the child be older, the 
dose must be proportionably increased. 

1241. 2. Where vomiting proceeds from some acrid or delete- 
rious substance being received into the stomach, this action 
should be encouraged by warm water, chamomile, or common 
tea, or even cold water, until the offending cause appear to be 
removed, which may generally be determined by no more of the 
offending substance appearing in what is ejected from the sto- 
mach. When this is the case, a brisk injection of a gill, (or 
more for an older child,) of warm water, and two large tea- 
spoonfuls of common salt, should be immediately given: should 
this not operate speedily, it must be repeated until an evacuation 
be procured. 

1242. If the injection operate freely, it will very frequently 
arrest the vomiting at once; but, should it not, it must be fol- 
lowed by one in which laudanum enters ; l the quantity regulated 
by the age of the child. Upon this subject there is one general 
rule, which it is well should be known ; namely, that a child will 
always bear by injection three times the quantity of laudanum 
it will bear by the mouth. The remedies named above (the lime- 
water, &c.,) may also be given, to aid the injection. 

1243. When the vomiting proceeds only from the child's 
having taken more into its stomach of its common, or even some 
unusual food, than it can well master, its effects will very gene- 
rally cease after it has thrown up the undigested articles; and 
the disposition to do this should be encouraged, as just directed, 
by the exhibition of warm water, &c. Should the vomiting not 

1 In this case the quantity of water taken, should not exceed a table-spoonful 
or two. 



326 OF SYMPATHETIC VOMITING. 

cease, however, when the stomach is freed from the offending 
cause, a stimulating injection of salt and water will almost cer- 
tainly put an end to it. 

1244. 3. When vomiting proceeds from the deranged powers 
of the stomach, it is almost always owing, in young children, 
either to an excess or deficiency of acid, or to the too great ir- 
ritability of this organ ; (and either of these may be occasioned, 
and most commonly is, by the stomach sympathizing with the 
gums, as in teething*;) or it may arise from some inscrutable 
cause, over which we can have no certain control, though we 
often have it in our power to interrupt the effect; or it may pro- 
ceed from some peculiar property in the mother's milk. 

1245. If it proceed from an excess of acid, the child will throw 
up its milk, completely curdled, in a few minutes after receiving 
it. The curd will be of different degrees of density, as the acid 
may be more or less abundant, or as the milk may have been a 
longer or shorter time in the stomach. This may be accompanied 
with either looseness or costiveness. If it be after the child has 
commenced to cut teeth, the bowels are, for the most part, loose ; 
but if before that period, it is very frequently attended by cos- 
tiveness. 

1246. When an excess of acid prevails, it must be relieved by 
antacids, in small but repeated doses. If the bowels of the child 
be loose, the best remedies we have found are magnesia and soda 
— the former in mixture, as follows: a tea-spoonful of calcined 
magnesia, mixed in eight or ten of water or milk, with three or 
four drops of laudanum, and a little sugar. A tea-spoonful of 
this every hour or two, very quickly allays the irritation of the 
stomach, and quiets the disturbance of the bowels. 

1247. Should the bowels be confined, the laudanum must be 
omitted and the mixture given until the bowels are opened. Or, 
should the bowels need no attention, the supersaturated soda 
w r ater, in small doses, will answer admirably well. If the child 
refuse to take the soda water, the lime water and milk, as just 
directed, may be given in repeated doses, until better. 

1248. In these cases, the mere destruction of this acid, in 
most instances, appears every way sufficient to relieve the sto- 
mach. This circumstance cannot fail to surprise, since at first 
sight, this would seem to be but removing the effect of a cause 
over which we do not know that we have any influence; for one 
of two things must happen, in these cases: either the acid is 
formally secreted by the stomach in too large a quantity; or the 
secretions of the stomach, by some peculiar disposition of this 
organ, become acid immediately after their formation. It is, 
therefore, difficult to understand how, on the first supposition, the 
destruction of the loose acid shall prevent the farther formation 
of it; and in the second, how it shall alter the action of the ves- 



OF DIARRHCEA. 327 

sels, so as to change the tendency of the secretions to become 
acid, when free in the stomach. 

1249. It must be recollected, however, that every instance of 
the child throwing up coagulated milk must not be considered an 
evidence of disease, or even of a superabundance of acid ; for this 
change in the milk must take place before digestion is accom- 
plished ; therefore, in the most healthy and vigorous stomachs. 
if vomiting be provoked some time after the child has sucked, 
the milk may be thrown up in this condition. 

1250. If there be a deficiency of acid in the stomach, and a 
vomiting be produced, the milk will come up unchanged — nausea 
almost always attends this variety ; the child may be observed to 
become pale, and evidently to struggle against the efforts of its 
revolting stomach. The milk is ejected with great force, in a 
large column; and, not unfrequently, a portion passes through 
the nostrils. 

1251. We have rarely seen this condition of stomach fail to 
be relieved by the occasional exhibition of small quantities of 
lemonade. The acid drink, however, should be stopped as soon 
as the ejected milk shows signs of separation. An injection of 
a little salt and water greatly promotes the recovery of the sto- 
mach. 

1252. Should the stomach possess too much irritability, the 
milk will be thrown up unchanged almost as soon as swallowed, 
and will not be permitted to tarry sufficiently long to become 
coagulated, however abundant the acid may be. In this case, 
the efforts of the stomach are not so powerfully exerted, and the 
milk is discharged from the mouth with less force. The child, 
under such circumstances, should be but seldom nursed, and but 
for a short period. It should not be suffered to fill its stomach. 
or it will be sure again immediately to discharge itself. From 
a quarter to half a drop of laudanum should be given in a little 
sweetened water, about fifteen minutes before it is nursed, and 
this three or four times a day. A salt and water injection will 
also be proper. If it proceed from some peculiarity in the 
mother's milk, her diet must be changed; should this not answer, 
a wet nurse must be procured, or the child weaned. 



CHAPTER XXVII. 



OF DIARRHCEA. 



1253. By this we understand a too frequent discharge of the 
feculent contents of the bowels, without tenesmus. The great 
variety of appearance in the matters discharged has rendered 
it proper to divide this disease into several species ; and, first, 



328 OF DIARRHOEA 



Sect. I. — The Feculent Diarrhoea. 

1254. Children under two years, or two years and a half old, 
are especially liable to this complaint. We shall cease to wonder 
at this, when we recollect the great length, sensibility, and irri- 
tability of the stomach and intestinal canal; the variety of parts 
with which they powerfully and almost constantly sympathize, 
(as the liver, the skin, the lower extremities, the brain, and the 
gums,) during teething; and the immense surface they present 
to be acted upon by acrid or other offensive substances received 
into them. 

1255. Therefore, whatever is capable of increasing the peri- 
staltic motion of the bowels, or even, perhaps, a portion of them, 
may occasion the disease in question ; hence the frequency of this 
complaint, especially during infancy; since, at that period, the 
bowels are decidedly more irritable, and many of the remote 
causes are constantly acting. 

1256. This increased action of the bowels, in this species of 
diarrhoea, may be occasioned both directly and indirectly: — di- 
rectly, 

1257. 1. By improper or irritating substances being carried 
into them; as food of a bad quality; or too much of that which 
may be good, when taken in improper proportions. This affec- 
tion may be caused by children receiving into their stomachs a 
vitiated milk ; or food of an irritating kind, as animal substances, 
either fresh or salt, before the stomach is capable of subduing 
them ; or such as shall undergo a vinous fermentation, as too 
much sweetening in their victuals, and this permitted to stand 
until this change is about to take place, before it be given. We 
have repeatedly known stale food occasion the complaint in 
question; or merely receiving proper food, but in excessive 
quantity. 

1258. In all the instances just supposed, the stomach not being 
able to digest its contents, the bowels become stimulated by the 
ill-subdued food urged into them, and make an effort to dislodge 
it as quickly as possible, by increasing their peristaltic motion ; 
hence, their contents are rapidly and successively transmitted 
through them, and occasion what is called the feculent diarrhoea. 
Or, it may be occasioned by the presence of bile in the duode- 
num ; this bile may be either in too great quantity ; or it may 
be highly depraved in its quality; and may, in either condition, 
so affect the peristaltic motion as to produce diarrhoea. 

1259. This species of looseness is almost always attended by 
some nausea, and a little pain : or such sensations as generally 
attend the exhibition of a cathartic of a stimulating kind, when 
it is about to commence its operation. This is the most simple 
form of diarrhoea ; and it very often effects its own cure by the 



OF DIARRHOEA. 329 

profuseness of its discharge; 1 but, should it not, a dose of mag- 
nesia, if there be any evidence of acidity, or castor oil, or rhu- 
barb, if there be none, will almost always be sufficient for this 
purpose. Should it not, it maybe repeated, but followed by an 
appropriate dose of laudanum at bed-time, should fever not be 
considerable. 

1260. We may remark, before we go farther, since the position 
is of constant application, that it is not a matter of indifference 
what substance we use as a cathartic in any one species of diar- 
rhoea ; for success will very often depend upon the proper choice. 
Thus, neither castor oil nor rhubarb would be so effectual as 
magnesia, in that diarrhoea in which the fasces had a predomina- 
ting acid in them ; nor would magnesia be so successful as either 
castor oil or rhubarb, where there was an absence of acidity, as 
it requires a combination, to a greater or less extent, with such 
a substance, to render it efficient. 

1261. It may be proper farther to remark that, during the 
operation of medicine, very little food should be given the child; 
and never any of a solid kind. The diet should consist of mu- 
cilaginous or farinaceous substances, but especially the former, 
as gum Arabic water; or it may consist of the other, as arrow- 
root, &c. 

1262. Should there be much nausea, .or many efforts to puke, 
it will always be best to cleanse the stomach ; as these symptoms 
are almost sure to rise from the presence of a portion of what- 
ever substance may have been offensive. For this purpose, we 
have ever found calomel, in proper doses, the best possible 
remedy; for it is almost as certain to produce vomiting, under 
such circumstances, as a medicine absolutely emetic, without the 
inconvenience of the latter remedy. The calomel, in such cases, 
had always better be given in divided doses — say, the full dose, 
divided into three parts, and a portion of it given every hour in 
a suitable vehicle, 2 until it effects the intended purpose. 

1263. The doses of calomel proper for the different ages and 
habits of children are easily ascertained when given, as just 
suggested, in divided doses ; as this medicine almost always acts 
with more certainty and promptitude, when thus given, whether 

1 At other times we may find the attack to be ferocious; being preceded by 
convulsions, and followed, as soon as sensibility is restored, by considerable pain 
in the bowels; fever, and this considerable; convulsive startings, &c. This 
particularly happens with children who have been over or improperly fed, or 
who possess an unusual degree of irritability, or who teethe with much difficulty. 

2 It is a matter of consequenceto attend to the vehicle in which calomel is 
given : its great weight prevents its being suspended in water, or any other equally 
thin fluid — it must, therefore, be mixed with a drop of syrup, almost of any kind ; 
or with a very small portion of loaf sugar, and maybe thrown dry into the mouth. 
It is also of much use to attend to the quantity as well as the quality of the ve- 
hicle, as much error is committed by employing vastly too much of it. The 
quantity should be no more than will entangle the calomel. 



330 OF DIARRHOEA. 

its operation be intended to be emetic or cathartic; and, at the 
same time, no possible risk is incurred, as the child cannot take 
in this manner an over dose. With the adult, we know that 
enormous doses are given by some; and this without any addi- 
tional motive, though, it is said, with a greater certainty of ulti- 
mate effect ; but this does not obtain in the child, where there 
is so much more irritability of system — and, of course, it must 
not be taken for a rule. Therefore, should a full dose be esti- 
mated to be six or eight grains, or even less, it must be divided 
into three or four portions ; one of which should be given every 
hour, until this quantity be taken, unless the previously exhibited 
parts have operated. And should this fail to have operated as 
an emetic, we may be pretty certain there is nothing offensive 
remaining in the stomach, and the calomel will sooner or later 
pass through the bowels. 

1264. We have made the above remarks with the hope they 
may diminish the fears so very often entertained of the violence 
of this medicine : we can truly say we have never witnessed a 
single instance of over-purging or puking from this drug. We 
do not mean, however, to convey the idea that it cannot happen ; 
far from it; for we are sure it might take place with it, as well 
as with any other medicine, injudiciously exhibited — we only 
mean that too much apprehension is frequently cherished when 
it is exhibited. Therefore, a grain or two more of calomel to a 
child beyond six or nine months of age is of no moment, provided 
this quantity be all the excess. Nor would we say there are 
not peculiarities of constitution which would prohibit the use of 
this medicine. These cases, however, are so very rare, as hardly 
to amount to an exception. But when they occur, they should 
be strictly attended to. 

1265. This complaint should never be neglected; especially 
at such seasons of the year as are most favourable for its pro- 
duction ; namely, during the excessive heat of summer, or when 
the weather becomes cool in the fall ; for when not attended to 
it is apt to degenerate into a habit, and to be of extremely dif- 
ficult removal. 

1266. 2. Indirectly. Diarrhoea may be induced by the bowels 
sympathizing with some other part, as with the skin, upon the 
sudden check of perspiration ; the application of cold to the 
surface of the body ; or by the improper use of the cold bath. 
With the brain, from agitation of mind, particularly that of 
anger or fear; or with the mere sight of a purgative, which the 
patient is reluctant to swallow. The latter of these causes, 
however, cannot be said to operate with children; and are only 
mentioned to prove the extent to which the bowels may sympa- 
thize. 

1267. When diarrhoea is produced by indirect agency, espe- 



OF DIARRHOEA. 331 

cially cold, it tvIII frequently continue, even after the cause which 
produced it is removed. This kind is rarely accompanied by 
pain, unless fever be excited; in which case the bowels suffer 
sometimes very much: the skin is often very hot and dry; con- 
siderable thirst, white tongue, and great fretfulness. There is 
almost always mucus mixed with the faeces, in such cases. 

1263. This case is treated very much like the former, except 
where pain and fever attend; then castor oil is the best remedy. 
This should be given in appropriate doses, 1 every two hours, 
until it operate freely ; or until the oil is observed to pass through 
with the faeces. If considerable pain continue after the opera- 
tion of the oil, the warm bath may be used most advantageously. 
If perspiration be excited, the fever will quickly pass, though 
the tormina of the bowels may remain. Should this be so, an 
injection, with a proper quantity of laudanum, may be given. 
This plan of purging, bathing, and giving laudanum, must be 
continued, as the symptoms may indicate, until the disease 
ceases. During the whole management of diarrhoea, the strictest 
regard should be paid to the diet and drinks of the patient. 
The former should consist of either of the diluted jellies of rice, 
tapioca, sago, or arrow root ; the latter should consist of thin 
flaxseed tea, barley water, rice water, gum Arabic water, or an 
infusion of the slippery elm bark. 

1269. Should the bowels be sympathizing with the gums, the 
disease will prove more obstinate, and, perhaps, be even conti- 
nued in a chronic form, especially if the early part of the disease 
have been neglected, or improperly treated. 

1270. The mouth, under these circumstances, requires atten- 
tion; for if the teeth give much irritation, the diarrhoea may 
continue as long as this lasts, however industriously we may ad- 
dress remedies to the bowels. In every case of this disease, 
where teeth can be suspected of having an agency in its produc- 
tion, the gum should be carefully examined; and, in doing this, 
the recollection of the general order in which the teeth are cut, 
(See Book I., p. 178, par. 656,) will greatly aid in the detection 
of the irritating teeth — but this order must not be scrupulously 
relied on ; for the deviations, as already noticed, are considera- 
ble. 

1271. Should the gums be swollen, they should be cut down 
to the teeth, and that freely — but if there be no swelling or in- 

1 Castor oil should always be made thin by warming, before it is given; and it 
is always easiest to take when it fe not mixed with any other substance. A large 
tea-spoonful is a dose for a child from one to three months old; a dessert spoonful 
for one from three to nine months old; a table-spoonful for one from nine months 
to eighteen months old. These are, of course, but very general directions, for 
only such can be given. Increasing, repeating, or diminishing the dose, must bs 
regulated by circumstances ; of which al most any body who has charge of children 
will be a competent judge. 



332 OF DIARRHCEA. 

fiammation in the gums, it would be as unavailing as cruel to 
lacerate them. As far as our experience goes, we think we are 
justified in saying there is no advantage derived from this ope- 
ration, when there is no evidence of irritation in the gums from 
the protruding teeth ; though we confess there are many experi- 
enced and intelligent practitioners in the habit of performing it. 
We think we are not deceived when we say we have never known 
the slightest advantage from dividing the gums, when there was 
neither inflammation nor swelling, though the teeth were rapid- 
ly making their appearance ; for the act of cutting teeth, as we 
have already said, (674) is not always attended by a sympathi- 
zing system. 

1272. We are aware that many are opposed to the use of lau- 
danum in the early stages of diarrhoea; but we think they are 
too indiscriminate in the rejection of this remedy. We are our- 
selves averse to its administration, where the bowels have not 
been liberally purged; where there is fever; and where there is 
no pain ; but where neither the want of due purging nor fever, 
make a contraindiction, we almost always give a small quantity at 
night, and especially if the child be very restless, or in pain. 
We are persuaded we very much abridge the complaint by this 
plan, and almost certainly prevent its running into a chronic 
form, after we have removed, as far as in our power, the ex- 
citing causes of the disease. 

1273. During the continuance of this disease, we strictly for- 
bid animal food or juices, under any form. 1 If the child be at 
the breast, let it be confined to it, if the mother have a sufficient 
supply; if she have not, let it be in part supported by reduced 
milk, and a little sugar. Its drinks may be very thin milk and 
water, barley, or rice water, or simply water, if it refuse those 

l We were not a little surprised to find the following observation from Dr. 
Cheyne, on the subject of proper diet for children ; namely, that " an animal diet 
produces less irritation than one which is solely composed of vegetable matter," 
p. 3b\ It is certainly contrary to our own experience, and, we had almost said, 
to that of every body else. We have ever found reduced milk, rennet whey, gum 
Arabic water, thin sago, tapioca, or arrow root, vastly more proper in all the 
complaints of the bowels, where nourishment may safely be permitted, than any 
animal juice, however much diluted. But we are persuaded that during the 
acute form of the disease, where purging is necessary, where there is pain and 
fever, the less of any thing the child takes into its stomach the better. For at 
this time the condition of the system is such, as not to require nourishment; or 
who wants " to feed a fever," or who ever knew pain arising from irritation, or, 
perhaps, inflammation of the bowels, relieved by cramming the child with food 1 
The only proper thing, at such times, is a little of the mother's milk, if the child 
be not weaned, or if weaned, milk and water, if milk be known to agree with it; 
or the occasional use of thin gum Arabic water. 

Besides, we would ask of what possible use can nourishment be at this time; 
since, from the deranged and irritated way, oftentimes, of the inflamed state of 
the stomach and duodenum, healthy or perfect digestion cannot be performed; 
and if it cannot, that which has been received, and not properly subdued by the 
stomach and duodenum, is an extraneous substance to these parts, and acts like 
one, by keeping up irritation. 



OF DIARRHOEA. 333 

just mentioned. No solid food whatever should be given during 
the existence of this complaint; and every kind of liquor, whe- 
ther fermented or distilled, should be peremptorily forbidden. 
The child should be more warmly clad than usual, unless the 
■weather be very warm. But its feet should be covered with socks 
or shoes, both by day and by night. If the weather be not ex- 
cessively hot, but especially if it be cool, the legs must be kept 
enveloped in woolen stockings, and its body in flannel; provided 
the disease be not in its active state, and accompanied by fever 
and a hot skin, and these parts not cold. 

1274. The greatest care should be taken that, through a mis- 
taken kindness, the child do not receive articles every way ag- 
gravating to the disease — such as fruits, (see Book I. p., 195,) 
meats, preserves, raisins, &c. ; and that it be not suffered to 
swallow the hundred infallible cures promulgated by newspapers, 
or recommended by officious and visiting gossips. 

1275. The child should not be permitted to sit on a damp or 
cold place; as stone or marble steps, pavement, &c. : nor placed 
so as to receive a draught of air, especially if its skin be dis- 
posed to moisture. 

Sect. II. — 2. Of the Bilious Diarrhoea, 

1276. In this species, the feces are loose, copious, and of a 
bright yellow or green ; and the bowels are stimulated to inor- 
dinate action, by an overcharge of bile, either vitiated or not. 
This complaint is very frequent among our children during the 
heat of our summers, or as the fall approaches. The influence 
of a hot sun upon the action of the liver is well known to every 
body; it is familiar to common observation, that after a spell of 
very warm weather, even the healthy evacuations of the adult 
give evidence of its rapid formation, and sometimes of its abun- 
dant absorption. Thus, the faeces are observed to be loaded with 
bile, and the urine to be deeply tinged with it ; and when the 
complaint of which we are treating seizes upon children, it is 
called "the summer complaint." 

1277. If the adult system, then, can be so inflamed by exces- 
sive heat, we need not be surprised that infants should suffer un- 
der the same power; and thi3, very often, independently of most 
of the remote causes enumerated under the first species. (1257.) 

1278. During our summers, the action of heat is both uniform 
and excessive: the liver feels its influence, and is forced to an 
inordinate secretion of bile, which, being suddenly and rapidly 
poured into the bowels, stimulates them to excessive action, 
either by quantity or quality, or both, and thus the bilious diar- 
rhoea i3 produced. 

1279. This action of the bowels, as in the species just consi- 



334 OF DIARRHOEA. 

dered, sometimes relieves them of their stimulating contents, and 
will thus effect its own cure — hence this species, like the other, 
may be ephemeral ; and not be more formidable than the feculent 
species, unless the formation of bile goes on almost indefinitely, 
or fever be provoked. 

1280. No period of infancy is free from attacks of this kind; 
and especially in summer, or early in the fall. We have seen 
extensive bilious evacuations from children of ten days old ; and 
from this time to every period of childhood, they are obnoxious 
to them. 

1281. We believe teething very rarely occasions this complaint, 
though it may very much aggravate the general symptoms by 
increasing the natural irritability of the system, and thus give 
rise to fever. Should fever take place, the disease becomes more 
formidable; not because the discharges from the bowels maybe 
increased, but because fever in itself, under all modifications, is 
formidable. 

1282. The plan of treating this form of diarrhoea will suggest 
itself; the bowels must be evacuated of their contents, and that 
by the remedy which so decidedly and successfully exerts a con- 
trol over the actions of the liver, namely, calomel in small but 
repeated doses, until, from the change in the appearance of the 
evacuations, it is judged the purging has been carried sufficiently 
far ; that is, when a little of the mucus of the bowels, or small 
coagula of milk, show themselves. 

1283. At night, in the absence of fever, the motion of the 
bowels should be tranquillized by a proper dose of laudanum 1 — 
preferably by injection if practicable; if not, it must be given 
by the mouth. Should this complaint reappear the next day, 
the calomel may be repeated, but at longer intervals, and only 
sufficient to procure a decided evacuation: this should again be 
followed by the anodyne, and so on, until the disease disappear. 

1284. The diet and drinks should be the same as before re- 
commended; (1273) except that rennet whey answers, both as 
nourishment and drink, an admirable purpose in this species of 
diarrhoea. 

1285. If fever attend, it will require more purging than if it 
be absent ; but, after the bowels have been properly evacuated 

1 The proper dose of laudanum for infants and children may be reckoned at the 
following rates. Haifa drop for a child under ten days old; a drop for one from 
That period to the end of the month : a drop and a half or two drops for one from 
that period to three months; three drops from this time to nine months; four 
drops from nine months to eighteen; five or six drops from that time to three years 
— then for every succeeding year a drop or two may be added. These doses are 
prescribed for children who are altogether unused to this drug; the power of bearing 
more may be rapidly increased by habit. In giving directions for the use of 
laudanum, we should always understand the habit of the child in this particular, 
and regulate the prescription accordingly. When laudanum is to be used as an in- 
jection, we may safely increase the quantity three or four fold. 



OF DIARRHOEA. 335 

by the calomel in the beginning, castor oil should be used; or, 
if there be evidence of acidity, that is, greenish or hard, small 
coagula of milk, magnesia, or magnesia and rhubarb, are the 
preferable laxatives. The occasional use of the warm bath will 
also be proper. Much advantage is found in giving very minute 
doses of the tartrite of antimony every two hours in this con- 
dition of the system 1 — it maintains the action of the bowels, and 
very much abates the force of the arterial system. Should the 
small quantity given produce puking, give but half the quantity 
until the stomach will bear a fuller dose, unless the bile be 
thrown up from the stomach — if so, encourage the discharge. 

1286. Mr. Burns says, "During the whole course of the dis- 
ease, it is proper to support the strength with light nourishment, 
such as beef tea, arrow-root jelly, toasted flour boiled with milk," 
&c. "The strength should be supported by small quantities of 
white wine whey, given frequently." (Vol. II., p. 195.) 

1287. This advice must be taken with considerable caution, 
especially in using the beef tea and the wine whey; as Mr. 
Burns himself admits that fever attends this complaint, and 
that there is much intestinal irritation. In every disease, almost, 
there is too much anxiety expressed for the strength of the pa- 
tient; it does not seem to be recollected that the patient and the 
disease are a unit ; and when you attempt to strengthen the one, 
you run the risk of increasing the other ; especially if this be 
done with stimulating articles of diet. It should also be recol- 
lected that debility is not disease — remove the disease, and you 
will rarely have trouble with the debility. Besides, where it is 
confessed there is much debility, it is never best removed by 
stimulants alone, unless every article of diet, however bland, or 
entirely vegetable, be considered as such. 

1288. Brown considers every thing as stimulants ; and he di- 
vides them into two general classes ; viz., the durable, as food 
of every kind; and the diffusible, as alcohol, in all its varied 
modifications, as brandy, wine, porter, &c. Therefore agreea- 
bly to this scheme, every thing taken as diet must be stimu- 
lating: let this be admitted: it will be conceded, at the same 
time, that they differ not only in force, but in their modes of 
action ; that they differ in possessing from the smallest to the 
greatest power; and that the force or power of the stimulant 
should be accurately proportioned to the state of the system. We 
will then say, agreeably to this arrangement, that each article 
of food, or of drink, must be considered as a stimulant of a 

' By small doses of the tartrite of antimony, we mean from the tenth or twelfth 
to the twenty-fourth part of a grain. It should be carefully dissolved in its pro- 
per or intended quantity of water, which should he accurately measured; the spoon 
by which the water was measured should be the one from which to give it. 



836 OF DIARRHOEA. 

given power, and come under one of the classes just named, 
durable or diffusible. But, on the other hand, it must be grant- 
ed that the true art of curing diseases consists in the regulation 
of stimuli to the force of disease, or rather to the susceptibilities 
of the system to be acted upon. 

1289. If this be true, and we believe it will not be disputed, 
the use of beef tea, a highly stimulating article, of the durable 
kind, and the wine whey, another, though not a very powerful 
one, of the diffusible kind, are decidedly improper in affections 
of the bowels, where fever and local inflammation exist, as they 
do, perhaps, in almost every ease of diarrhoea. 

1290. It may be said Mr. Burns does not recommend them, 
where there is fever — he does not expressly; but he tells us, 
that " during the ivhole coarse of the disease it is proper to sup- 
port the strength with light nourishment; such as beef tea," &c, 
and "by small quantities of white wine whey, given frequently." 
(loc. cit.) Now, what are we to understand by the whole course 
of the disease, but from its commencement to its termination? 
and fever which he admits to accompany this disease, at least 
sometimes, can have existence but during some one part, or the 
whole of this period ; therefore, the wine whey and beef tea, 
must be given when fever is present; since it is, agreeably to 
Mr. Burns, "proper to support the strength during the whole 
course of the disease." 

1291. If we can place any reliance upon the accuracy of our 
own observations, we can with much safety declare, that beef 
tea, or any other diluted animal extract, has uniformly been at- 
tended with bad consequences, in the commencement of almost 
all affections of the bowels ; and this from a twofold action : 1st, 
it is too stimulating when applied to the surface of the irritated 
bowels ; and, 2dly, in affording too much nourishment for the 
febrile condition of the system. The wine whey, though a novel 
remedy to us in acute bowel complaints, is still more exception- 
able, from its mode of action, than even the beef tea ; therefore 
we should forbid it; as we make it a first and positive direction, 
that no animal substance of any kind, or in any form, shall be 
given in diarrhoea, even its most simple form, when attended 
with bilious discharges ; and we as positively prohibit liquor of 
every sort. AYe have none of those overweening apprehensions 
for the strength of our little patients, that would lead us to cram 
them with nourishment; consequently, we make very little pro- 
vision for their support, believing the first object is to free them 
from disease, by the most prompt and efficacious means in our 
power ; and until we do this, in acute diseases, we permit strength 
to take care of itself. 

1292. But we must not be understood to forbid all nutritious 
substances to the child; this we do not do; but we are very 



OF DIARRHffiA. 337 

particular, both as regards quantity and quality, when nourish- 
ment is permitted. The other articles enumerated by Mr. B., 
(arrow root, boiled flour, &c.) we employ, occasionally, in small 
quantities, as well as rice water, barley water, gum Arabic water. 
thin sago, and tapioca; and rennet whey, during the period of 
purging, if the child be weaned; but if it be not, we confine it 
to the breast for nourishment, 1 and to barley or rice water for 
drink. 

1203. It may be proper to observe that, in the species of 
diarrhoea we are now considering, we have not made, as some 
have, (Good, &c.) yellowness of the evacuations essential to it — 
we very often see them of various shades of green, from the 
bright grass green, to the bottle, or almost black green; this is 
sometimes accompanied by a frothy top, or the whole mass look- 
ing spongy, resembling very much the green production on 
the top of stagnant water; at other times, it is of pitchy dark- 
ness and tenacity. Where this last is observed, it has always 
been preceded by a pretty obstinate fever, which does not 
usually yield until these black evacuations come away. 

1294. The bile, beside several other purposes, is supposed to 
neutralize the acid formed in the stomach; and when this, as 
well as the bile, is abundant, it may give a tone of green to the 
evacuations. This use of the bile must necessarily be important 
in infancy, where there is so strong a tendency to generate acid; 
or for the ingesta to become so, by tarrying long in the stomach 
and bowels. Where, then, the bile is deficient in quantity, or 
the acid more than usually abundant, we have not only green 
stools, but oftentimes very frequent ones; owing, doubtless, to 
the presence of so much loose acid coming in contact with the 
mucous coat of the intestines; hence the utility of absorbents 
in such cases, and the almost immediate cessation of diarrhoea 
after their exhibition, if they be purely absorbents, 2 as the pre- 
pared chalk, oyster-shells, &c. But as absorbents can only be 
given with advantage where there is an excess of acid, they 
should be given with much caution where this is not satisfac- 
torily proved to exist; especially where there is febrile irritation 

1 We even limit this sometimes; especially where there is much fever or when 
there are many milk coagula discharged. In such cases, we permit the child 
to be seldom nursed, and then the above nourishment to be given in but small 
quantities. 

a We say, purely absorbents; by this we mean where the union with an alka- 
line earth will not form a purgative compound — thus, when the carbonate of lime, 
as in chalk, meets with an acid, the tertium quid will not be purgative. But 
should we give magnesia, confessedly an absorbent, the union of the acid with it 
improves its cathartic qualities; and of this we often take advantage, in certain 
conditions of the bowels. Hence, the risk which is sometimes incurred by the 
incautious use of the " cretaceous mixture," as suggested, (1295) by immediately 
putting a stop to the motion of the bowels. 

22 



338 



OF DIARRHCEA. 



attending the diarrhoea, as almost always happens when this com- 
plaint arises from teething. 

1295. Much injury has been sustained by mistaking green bile 
for acidity, and administering the cretaceous mixtures : authors 
abound w 7 ith cases of cholera, convulsions, fever, &c, arising 
from this cause. It, therefore, becomes very important that the 
one should not be mistaken for the other. But we shall have 
occasion to revert to this subject presently. 

1296. Where a bilious diarrhoea has continued for some time, 
either from the force of the remote cause, neglect, or ill treat- 
ment, and has been attended pretty uniformly by green and slimy 
stools, 1 we have often the satisfaction of seeing them speedily 
change to a bright yellow : this change in the appearance of the 
discharges is almost a certain sign that the disease is about to 
yield. This has been effected by ordering a proper regimen ; 
regulating the heat of the body; covering the limbs with woollen 
stockings ; applying flannel to the abdomen ; prohibiting impro- 
per drinks ; withholding " infallible remedies ;" lancing the gums ; 
by the use of small doses of calomel, and the occasional exhibition 
of laudanum, either by the mouth, or by enemata. 

1297. In this stage of the complaint we are sometimes aided 
very much by giving lime water and milk, in equal portions, 2 
several times a day; or sometimes by having their milk diluted 
with it instead of common water, where the child is either 
weaned, or is obliged to be supported in part by artificial means. 

Sect. III. — Mucous Diarrhoea. 

1298. The evacuations consisting of, or containing, a copious 
discharge of mucus. This species is commonly produced by a 
sudden check of perspiration, or the sudden application of cold 
to the surface of the body and the feet, especially in adults. We 
have seen it follow, in two instances, in children, the improper 
use of the cold bath. Children have been seized with this com- 
plaint from the sudden transitions of the atmosphere, where 
they have not been properly protected. This species is, perhaps, 
the only one in which the teething of children have not been ac- 
cused of an agency. 

1299. The discharges in this complaint are not so frequent, 
by any means, as in the species we have just been considering. 
There is sometimes a little forcing or tenesmus, and occasionally 
a little blood. The feces are, for the most part, of a light green, 

1 By slime, we do not mean the mucous secretion of the bowels, which is white 
or whitish, tinged with a little blood ; but a tenacious bile, itself of a green colour, 
though not, perhaps, so intense as the general substance of the evacuation. 

3 The dose of lime-water and milk may be a teaspoonful of each every hour or 
two for children under six months; double this quantity, or even more, for older 
children. 



OF DIARRH(EA. 339 

and not very abundant, unless procured by medicine ; then, often- 
times, they are very copious, and offensive. A little mucus al- 
ways precedes the feculent matter, and is almost sure to be fol- 
lowed by it. For the first few days, the mucus resembles that 
yielded by the nose in catarrh; after this, it becomes thicker, 
less transparent, and in a short time more purulent; and when 
purulent in its appearance, it is almost always found to be 
streaked with a little blood. This change is generally favour- 
able, and bears a strong analogy to what takes place with catarrh, 
when about to get well. It, therefore, rarely requires any thing 
more than persisting in the demulcent food and drinks recom- 
mended above, unless the stools now become numerous, thin, 
and very yellow or green : -in this case, a little rhubarb tea, 1 
with very minute doses of laudanum, will be found to answer 
admirably well; but the mucilaginous drinks must be constantly 
persisted in. 

1300. Fever rarely accompanies this complaint in its milder 
forms ; and it is of easy management, in general, with children ; 
but in adults we have known it very obstinate. The remote 
cause should not be repeated, if it proceed from cold bathing; 
but removed, or its operation prevented, if from cold, by addi- 
tional clothing, &c. 

1301. The bowels should be gently purged by castor oil, and 
its operation followed in the evening by a suitable dose of lau- 
danum. This plan must be pursued daily, until the bowels be 
relieved; or they may be purged by rhubarb and magnesia during 
the day, and followed, as before directed, by an anodyne in the 
evening. The diet should consist of such articles as have been 
already directed ; and the patient take freely of an infusion of 
slippery elm bark, or gum Arabic water. 

1302. Dr. Good condemns the use of purgatives in this species 
of diarrhoea ; but upon no good ground, that we can perceive — 
our experience is decidedly in favour of the plan just proposed ; 
that is, mild doses of castor oil, or gentle doses of rhubarb and 
magnesia in the beginning of the disease. If, by purgatives, 
Dr. G. mean no more than laxatives, we would agree with him. 
He would certainly give laxatives in dysentery, so as to procure 
one or two fecal evacuations per diem, 2 to which it bears some 
analogy, as far as regards effects and appearances; only in the 

1 Rhubarb tea; take half a drachm of bruised rhubarb — pour on it a wine glass- 
ful of boiling water — let it stand until cool— strain, and add a little loaf sugar to 
it. A tea-spoonful every two hours should be given until it colours the stools. 

2 This, however, is now considered a very doubtful practice. Owing to the 
rapid strides pathology is making, we are informed that more or less inflamma- 
tion is present in all these affections of the bowels, and consequently, that in diar- 
rhoea, or (especially) in dysentery, purging is not admissible; but we may always 
keep them open, (that is,) a stool a day may be procured by some mild cathainc, 
as castor oil, or a little rhubarb, or flake manna, &c. 



340 OF DIARRHEA. 

mucous diarrhoea there is, in general, no vascular excitement, 
and, therefore, most probably, no inflammation, though certainly 
irritation ; whereas in dysentery more or less inflammation al- 
ways attends. 

1303. Dr. Good, and others, recommend in this affection, or 
in any "other looseness produced by a sudden chill upon the 
surface, small doses of ipecacuanha, with or without opium." "We 
have used this prescription at night, and, we think, with evident 
advantage; but it should not be given in the day, unless there 
be considerable pain ; and then only after an evacuation of feces 
has been procured. 

Sect. IY. — Chylous Diarrhoea, 

1304. This form consists of chylous or milky evacuations. It 
would appear that there is a deficiency of bile in this disease, as 
the dejections are not tinged with this substance — consequently, 
this complaint would seem to be necessarily accompanied by some 
derangement of the he.patic system, either positively or accident- 
ally. The liver may not be in a condition to secrete this fluid 
abundantly, or its flow into the intestines may, by some means 
or other, be impeded. 

1305. We are inclined to believe in the first, rather than in 
the second condition of the liver; since we have never witnessed, 
that we recollect, this complaint being attended by jaundice. 
But why the lacteals should refuse to take up the chyle after it 
is formed, is very difficult to say; yet we know there is a strong 
consent between the liver and the lacteals, as emaciation takes 
place very rapidly when that viscus is much deranged; or, the 
lacteals may, like the intestines themselves, require the presence 
of a certain quantity of bile, to be healthfully stimulated. 

1306. Do the lacteals really refuse this fluid? — or is it only 
supposed they do not absorb any, because they do not take up 
the whole ? Would this want of absorption really prove an in- 
capacity to do so? May not the fluid ejected from the bowels 
be very far from a well concocted chyle ! — and may it not, in 
consequence of this, lack the appropriate quality to stimulate 
them to the act of absorption ? 

130T. We have seen this complaint make its appearance sud- 
denly in children, after weaning; and we have seen it make its 
approach gradually, after a pretty long continuance of bilious 
diarrhoea. In both these cases, we have supposed the digestive 
organs, particularly the duodenum, to be in fault, rather than 
the lacteals, or- mesenteric glands. We have believed that the 
product of digestion has been ill elaborated, as well as too speedily 
passed through the bowels. The appearance of the dejections 
would seem to prove the first, and its quantity and fluidity to 
countenance the second. 



OF DIARRIKEA. 341 

1308. In consequence of ill elaboration, the chyme must pos- 
sess new or unusual properties; possessing new properties, it 
would be likely to act upon the susceptible bowels almost as a 
foreign substance ; and they would, in consequence, be urged to 
an increased peristaltic motion ; or become passive, by not being 
duly stimulated. And the absence of bile may be adduced in 
support of the belief of this absence of a certain quality in the 
chyme; since the extremity of its duct is not properly stimulated 
to pour it out. 

1309. When a child is seized with this complaint, it very 
rapidly becomes weak, and emaciates with surprising suddenness, 
and, if not relieved pretty soon, it becomes exhausted for want 
of nourishment. 

1310. In treating this complaint, whether it be suddenly in- 
duced, or it follow a diarrhoea, we have always prescribed for the 
condition of the stomach; and we may safely say we have gene- 
rally succeeded. We should withhold almost all food from the 
stomach, that its weakened powers need not be longer over-taxed. 
We, therefore, confine the child to small quantities at a time, of 
rennet whey or gum Arabic water: nothing else is permitted. 
We endeavour to restrain the passages by an anodyne injection 
of full power at night; and give, during the day, minute doses 
of calomel — say, a quarter grain every four hours, with the 
twentieth of a grain of opium. We persevere in this treatment 
for a few days, unless the calomel urge the bowels too much. In 
this case, we diminish the quantity of the calomel, and increase 
that of the opium. We have thought we have derived advan- 
tage from the application of a blister to the back of the neck, 
and keeping the whole body unusually warm. 

1311. We have seen the most decided relief from this plan; 
and giving the stomach very little to do, it becomes reconciled 
to its duties, and fulfils them after a little while perfectly. 

1312. Query: Would small quantities of bile, exhibited in 
some form or other, be useful in this complaint? 

Sect. V. — Lienterie Diarrhoea. 

1313. " The rapid passage of the nearly unchanged aliment 
through the bowels constitutes this species of diarrhoea." With 
children it sometimes follows the other species of diarrhoea, but, 
perhaps, oftener dysentery. It is not accompanied by much 
acute pain ; though the child appears uneasy after eating ; and 
is immediately relieved by an evacuation taking place, which is 
perceived to consist of the food taken into the stomach a little 
while previously. This complaint rarely comes on suddenly ; 
and it may exist in different degrees. When a tendency to this 
complaint is first perceived, it should be instantly attended to; 
for it is one of those affections that rarely, if ever, cures itself. 



3-12 OFDIARItHCEA. 

1314. It generally commences during the chronic state of di- 
arrhoea, by showing, perhaps, that some one article of diet only, 
has passed the bowels unchanged, as potato, apple, or other vege- 
table substance, or fruit, which has been incautiously given to 
the child. This is pretty soon followed by other articles, as 
meat, &c. ; and, finally, every thing, almost, that enters the 
stomach, is speedily conveyed through the intestines, with little 
or no appearance of having been acted upon by the powers of 
the stomach. The appetite is sometimes voracious in this disease, 
and the thirst is always considerable. 

1315. Dr. Good declares, "The bile, as in the case of chylous 
diarrhoea, is not duly secreted, or is obstructed in its passage ; 
for, were there a free flux of bile, the feces, however crude and 
unconcocted, would display their common hue, which they rare- 
ly exhibit." This is not altogether accordant with our experi- 
ence ; we have rarely if ever failed to see bile in a greater or 
less degree accompanying the lienteric discharges, and, some- 
times, Ave have seen the food imbedded in a quantity of pure bile. 
That the functions of the liver may be impaired or vitiated in 
this complaint, we have no hesitation to believe; but that the 
secretion stops altogether, or that its passage is obstructed, as a 
common event, we cannot accede to ; at least, when it happens 
with children ; and we confess ourselves not to be familiar with 
it in adults. 

1316. If no bile were secreted, none could appear in the stools ; 
but Dr. Good seems to confess there is, occasionally, the pre- 
sence of bile in them, though he says they "rarely exhibit" it. 
We, on the contrary, say we do not recollect an instance in 
which there was a total absence of this important fluid in the 
stools. It may readily pass unobserved, if it be not looked for ; 
since the frequency of stools is sometimes so great as to attach 
but little bile in their course. There cannot be an obstruction 
to its flow, as there are no signs of jaundice. 

1317. This complaint seems to be seated altogether in the 
stomach itself, and owes its existence to the too great irritability 
of this organ ; for no sooner is food lodged in it, than it makes 
efforts by an increased peristaltic action to discharge it; and 
the intestines transmit it with equal speed to their extremity, 
there to be discharged. Dr. Good suggests that "the gastric 
juice may not be secreted in proper quantity or with proper 
qualities:" this may be; but it is not sufficient to account for 
the phenomenon ; for this happens precisely in dyspepsia, but 
dyspepsia is not attended with lientery. 

1318. We have been in the habit of treating this disease very 
much after the manner of "chylous diarrhoea," to which it has 
a very strong resemblance, in the rapidity with which the food 
is passed through the tract of the intestinal canal; and would 



OF DIARRHCEA. 343 

seem to be but an excess of it : in the one, the stomach digests 
to a certain extent, but confessedly imperfectly ; as the ill-con- 
cocted mass is hurried from the stomach into the intestines be- 
fore it can be properly elaborated. In the disease in question 
it tarries a still shorter time ; and, for the most part, passes with 
little or no change. Our plan of treating this complaint will be 
better understood by relating one of a number of cases which 
have fallen under our notice. 

1319. The daughter of L. A., aged ten months, had a pretty 
serious attack of bilious diarrhoea, in consequence of her teeth 
passing with difficulty through the gums. She was, however, 
relieved of this by small doses of calomel, the occasional use of 
laudanum, and by cutting the gums. Being an only child, and 
a great pet, especially with two or three aunts who were doomed 
to "single blessedness," she was too early indulged in improper 
articles of food, though she was ordered to be confined to the 
milk of her mother. She was permitted to taste of every thing- 
she craved, though several of these articles were observed to 
pass the bowels unchanged — among these were portions of Irish, 
and sweet potatoes, and raisins. This gave no alarm to the 
loving aunts, or to the inexperienced mother; and she was per- 
mitted for awhile longer to gratify her capricious desires, until 
the stomach lost control over every thing received in it; and, of 
course, its contents were transported through the bowels un- 
changed. We were now again sent for. 

1320. There was neither nausea nor vomiting in this case; 
but the thirst was great; the urine small in quantity; high-co- 
loured, and of a very strong smell. The child began to fall 
away, and its strength to decline rapidly. We ordered that no 
kind of food whatever should be given, save that of the milk of 
the mother, and that only once in four hours, and then not in 
full quantity. Should the thirst require more fluid than the 
milk to satisfy it, giving from time to time a tea-spoonful of cold 
water. To put woollen stockings on its legs ; flannel it was al- 
ready wearing on its body. To have the abdomen rubbed three 
or four times a day, for ten minutes at a time, with the bare 
warm hand. To not awaken the child when asleep, under any 
pretence whatever. To have her taken across the river in the 
steamboat two or three times in the afternoon, when the weather 
was suitable. 

1321. In addition to this, she was to take four drops of cha- 
lybeate wine, and a quarter drop of laudanum, every two hours, 
in a few drops of sweetened water, when awake. This plan was 
pursued for two or three days before any change was perceived; 
but, at the end of this time, it was observed that the food re- 
mained rather longer in the stomach after nursing, though the 
milk seemed to pass off unchanged, with some small tinges of 
brighter yellow than before. 



344 OF DIARRHCEA. 

1322. Thinking advantage might be derived from stimulating 
the external surface of the abdomen more powerfully than by 
the frictions of the hand, we ordered the tartar emetic ointment 
in the proportion of a drachm of the tartrite to an ounce of 
simple cerate; a portion of this to be applied once a day over 
the whole surface. The quantity of laudanum was increased to 
half a drop, every two hours; the nursing, drink and exercise, 
as before. 

1323. At the expiration of three more days, the discharges 
from the bowels were less frequent; the milk was perceived to 
be slightly curdled; 1 the bile more evident, the urine rather 
more abundant, and the skin of a more uniform and natural 
warmth. The ointment had produced no effect upon the skin ; 
it was ordered to be rubbed twice a day — no increase of nourish- 
ment, and the same drink. 

1324. At the end of three more days the stools had become 
less frequent; they bore evident marks of digestion, and were 
assuming a more decided tone of yellow. The skin was begin- 
ning to show signs of irritation: the ointment continued; the 
laudanum increased to three fourths of a drop, the nursing, drink 
and exercise, to be continued as before. 

1325. At the expiration of another period of three days we 
found every thing much changed for the better — had had but 
two evacuations for the last twenty- four hours — digestion much 
more decided ; stronger evidences of bile ; the urine much freer, 
lighter coloured, and less rank in smell. The skin of the abdo- 
men pretty much irritated. The laudanum was not increased ; 
the nursing was permitted to be a little more in quantity, but 
not oftener ; the water was now sweetened with a little loaf-sugar, 
as the thirst was considerably abated. 

1326. Another interval of three days had passed. One stool 
only per diem, but it was large ; some portions of white curd, 
mixed with the new yellow faeces — faeces pretty offensive ; urine 
sufficiently abundant ; the abdomen much irritated ; the skin and 
pulse natural. It may be well to observe that the pulse was 
little or none affected during the whole time, on which account 
we did not notice it hitherto in our reports. 

1327. As the mother's milk was sufficient in quantity, as well 
as good in quality, we ordered the child to be exclusively con- 
fined to it — but that it might be nursed rather more frequently, 
to permit the vesications on the abdomen to heal gradually: to 
continue the laudanum, but much less frequently, say three or 
four times a day; and, should the bowels now become rather 
confined, of which, of course, there was a risk, to have them 
opened by an injection of molasses and water. 

1 In some cases there appears to be an excess of acid; and the milk passes 
through in the form of whey and coagulum. 



OP DIARRIKEA. 345 

1328. The child was now ordered to the country, from which 
it returned, in about three weeks, in perfect health. 

1320. We have found this disease, generally speaking, to be 
a manageable one, when sufficiently early attended to ; but when 
suffered to run on to the last stage of debility, little or nothing 
can be done. Or when it occurs in the adult, it but too gene- 
rally proves fatal, as it for the most part takes place in feeble 
and worn out constitutions, from hot climates, after chronic 
dysentery or diarrhoea. 3 

1330. There are several more varieties of diarrhoea, but of 
which we have never seen cases; and, consequently, can say no- 
thing from our own experience ; nor has the experience of others 
discovered any certain method of cure. Besides, they appear to 
belong exclusively to the adult — at least, we have never wit- 
nessed them in children ; such are diarrhoea serosa, tubularis, and 
gypsata. 

1331. In our account of the several diarrhoeas which we have 
just passed, our histories, and the method of cure, have refe- 
rence principally to their acute or sub-acute stages. We shall 
now occupy a few minutes upon these diseases, when they have 
assumed a chronic form. But it may be proper to observe it is 
not necessary to keep up the distinction of species, as they ap- 
pear to merge into one common form of disease, after they be- 
come chronic. 

1332. Thus, the feculent, the bilious, and the mucous, may 
become chronic, and require but little if any variation of treat- 
ment. This especially happens when these diseases are neg- 
lected, about the period of teething and weaning. Several 
writers have described this disease, as De Salle, Cruveilhier, 
Hamilton, &c. ; but none so well as Dr. Cheyne. Mons. Andral 
has been very attentive to the chronic form of diarrhoea, and has 
made many post mortem examinations : they agree very much 
with those of Dr. Cheyne, as regards the state of the mucous 
membrane, and of the intestines themselves. 



Sect. VI. — Of the Chronic Form of the Diarrhoea of Infants. 

1333. We have said that several of the species of diarrhoea 
already treated of may be made to run into a chronic form, of 
very difficult management, as well as of great danger; 1st, by 
neglect; 2dly, by the continuance of the remote and exciting 
causes; or, 3dly, by improper treatment; thus, those children 
who have been too early weaned, improperly fed after weaning, 
or separated from the breast at an improper time, are more 

1 It will be well to observe that all animal substances are inadmissible in com- 
plaints of the bowels. 



346 OF DIARRH(EA. 

obnoxious to it than those who have been more properly ma- 
naged. 

1334. The form of the disease which we are about to describe 
occurs sufficiently often in this country to make it formidable; 
but is of much more frequent occurrence in Europe. It would 
seem, also, to be more common in one portion of country than 
in another; thus, in Scotland, agreeably to Dr. Cheyne, it is a 
disease of frequent occurrence ; less so in England ; and in 
France, according to De Salle, it was considered an epidemic. 
There the disease acquired the name of " Maladie de Cruveil- 
hier," because this physician first described it there, though it 
is essentially the same as that so well detailed by Dr. Cheyne, 
under the name of "Atrophia ablactatorum," or "weaning 
brash." 

1335. We have just hinted that the " Atrophia ablactatorum," 
or " weaning brash," was nothing more than the chronic form of 
the several species of diarrhoea to which infancy is liable. And 
though this complaint is confessedly more common at the period 
of weaning, or immediately after the child is separated from 
the breast, it may occur at other periods, and from other causes. 
Every diarrhoea, after it has continued from fourteen to sixteen 
days, may be considered as chronic; therefore, the disease so 
ably treated of by Dr. Cheyne, must be considered only as a 
perseverance of the common diarrhoea of children, during sum- 
mer and fall, and not a new and distinct disease. This is con- 
firmed, we think, by the phenomena, the causes, the mode of 
treatment, and the post mortem examination. For even the 
feculent diarrhoea, or the cholera crapuloso of infants, may be 
continued to a chronic form ; and when it has assumed this it 
presents like phenomena. 

1336. Dr. Cheyne, (p. 16,) describes this disease as commen- 
cing "with a purging and griping pain, in which the dejections 
are of a green colour." So do the diarrhoeas of infancy, very 
often, let the period of attack be when it may; for though, in 
the mild forms of this disease, especially in the very beginning, 
the stools are for the most part yellow, yet they are not so ne- 
cessarily — for we have a hundred times seen them green from 
the very first discharge. 

1337. "When this purging is neglected, and after continuing 
for some time, there is added a retching, with or without vomit- 
ing : when accompanied by vomiting, the matter brought up is 
frequently coloured with bile," (p. 16 and 17.) Is this not 
precisely what happens in all looseness ? Nothing is more com- 
mon in a diarrhoea of some standing than this affection of the 
stomach, or this appearance of the matter thrown up. 

1338. " These increased and painful actions of the alimentary 
canal produce a loathing of every kind of food, and naturally 



OF DIARRIICEA. 347 

are attended with emaciation and softness of flesh, with restless- 
ness, thirst, and fever," (p. 17.) Is this not the ordinary march 
of neglected, or ill-treated diarrhoea? 

1339. "After some weeks, I have observed a hectic blush on 
the cheek ; but the most characteristic symptom of this disease 
is a constant peevishness, the effect of unceasing griping pain, 
expressed by the whine of the child, but, especially, by the set- 
tled discontent of its features ; and this expression of discontent 
is strengthened towards the conclusion of the disease, when the 
countenance has shared in the emaciation of the body," (p. 17.) 
"Who has not observed all that is said here, when diarrhoea had 
become protracted, and was hastening towards a close? 

1340. "In the progress of the disease, the evacuations from 
the belly show very different actions of the intestines, and great 
changes in the biliary secretions ; for they are sometimes of a 
natural colour, at other times slimy and ash-coloured, and some- 
times lienteric," (p. 17.) Every author who has written on the 
subject of diarrhoea describes this mutable complexion of the 
feces in this complaint. 

1341. "The disease seldom proves fatal before the sixth or 
seventh week: I have seen, though rarely, a child recovered, 
after the disease had continued three or four months : and, 
again, I have seen the disease cut short by death, in the second, 
third, or fourth week, before it had reached its acme ; the sudden 
termination having been occasioned by an incessant vomiting 
and purging, or by convulsions, from the immense irritation of 
the bowels," (p. 18.) Cannot every practitioner of any experi- 
ence declare he has witnessed the same abrupt and unexpected 
termination of our summer and autumnal diarrhoeas ? 

1342. " The disease is more frequent in children who have 
been weaned before the eighth or ninth month, and, in particular, 
in those who, in consequence of some accident happening to the 
nurse, have been weaned abruptly," (p. 18.) These observations 
comport with all experience in this complaint; especially in 
this country. So well aware are mothers of this fact, that 
they never wean their children at this period, bat from absolute 
necessity. 

1343. "This is a disease of the autumnal months. I have 
seldom seen it, comparatively speaking, commence before the 
solstice, nor after the end of the year; and I suspect that it is 
most general in sultry seasons." This agrees with the periods of 
our diarrhoeas of children, entirely. This complaint is most rife 
with us from the beginning of July to the beginning of October. 
It is certainly, too, more frequent in our damp, hot summers. 
We believe that moisture contributes considerably to the pro- 
duction of this complaint, since the functions of the skin are 
less perfectly performed than in dry summers. Our present 



348 OF DIARRHCEA. 

summer, (1825,) is, perhaps, unparalleled in the recollection of 
any body, at least, for the intensity and the long continuance 
of its heat, and the dryness of the atmosphere ; and is so far, 
(August,) unparalleled for its healthfulness. The bowel com- 
plaints of children are few, and of easy management, when 
compared w T ith other seasons. 

1344. "At the time when weaning brash comes on, the teeth 
are usually appearing ; and from a common notion that a flux 
is wholesome during teething, the disease is sometimes allowed 
to make an irremediable impression on the constitution before the 
physician is called." In this there is the most perfect coinci- 
dence with our "summer complaint," both as regards period and 
consequences. 

1345. The post mortem appearances detailed by Dr. Cheyne 
correspond with those made in this country, as well as those by 
Andral and Cruveilhier, in France. They are every way so 
interesting and important, that w r e trust we shall be excused for 
quoting them, especially as they are short. 

1346. "In every instance I observed that the intestinal canal, 
from the stomach downward, abounded with singular contrac- 
tions, and had, in its course, one or more intus-susceptions ; that 
the liver was exceedingly firm, larger than natural, and of a 
bright red colour, and that the enlarged gall-bladder contained 
a dark green bile. In some dissections the mesenteric glands 
were swelled and inflamed ; in others, however, these were 
scarcely enlarged, and had no appearance of inflammation." 

1347. "These contractions and intus-susceptions are entirely 
of a spasmodic kind, as in the latter the contained part of the 
gut was easily disengaged from that which formed its sack ; and 
in no part of the entanglement were there adhesions, or even 
the marks of inflammation ; and the contracted portions of the 
intestines were again permanently dilated, by pushing the finger 
into them," (p. 22 and 23. a ) 

1348. "These appearances lead me to imagine that the wean- 

1 Intus-susception is, perhaps, among the most frequent causes of death, when 
this disease has run on so long. It has been observed by almost all writers that 
this form of diarrhoea terminates sometimes very suddenly, by violent vomiting, 
or convulsions. Now, is it not more than probable, in these cases, that the im- 
mediate cause of death may have been the invagination of the intestine? 

This condition of the bowels would seem to exist much oftener than is suspected ; 
and to an extent that is almost incredible : thus Mr. Burns informs us that in one 
case no fewer than forty-seven intus-susceptions were found in the same body; 
and that invagination of the intestines is the most frequent cause of fatal diarrhoea ; 
that not less than fifty cases had occurred to his brother, in the course of his dis- 
sections. (Vol. II. p. 199, James' Ed.) 

This condition of the bowels unquestionably occurs where no suspicion is en- 
tertained of its existence; for we have no certain diagnostic of intus-susception. 
In general, it may, however, be remarked, where there is more than usual pain; 
bloody slimy stools; violent vomiting, sometimes of fseces, and convulsions, this 
situation of the bowels may be suspected. 



OF DIARRHOEA. 349 

ing brash, in its confirmed state, is imputable to an increased 
secretion of acrid bile, or rather to the morbid state of the liver. 
which occasions this." (P. 23.) 

1349. In the chronic form of this disease we can readily 
imagine the hepatic system to be deranged ; and the secretions 
of the liver, by being either imperfect in their kind, or acrid in 
their quality, may over stimulate the already severely irritated 
intestines, either to profuse secretion, inflammation, inordinate 
action, or spasm. The first, or profuse secretion, may account 
for the quantity of the matter discharged; while the others may 
serve to explain the various appearances of the dejections, their 
great frequency, the state of contractions, and the intus-suscep- 
tions of the intestines. Thus, while the stomach and bowels 
preserve their powers, or are but very little impaired, we see 
the fteces of a yellow colour and pretty abundant; or they may 
be even green, without their being very seriously implicated ; 
provided the tone of green be not very intense, pretty uniform 
in consistence, and somewhat gelatinous. 

1350. When the boAvels are more severely irritated, as almost 
always happens after the disease has continued for ten or twelve 
days, and more or less inflammation present, there is strong 
evidence of the liver participating in the affection, by the in- 
creased quantity of bile ; this now becomes flocculent, as it were, 
of a deeper colour, and not unlike green chopped rue, with co- 
pious watery discharges. When the bowels are still more urged 
by increased or more extensive lesion, the stools become of a 
brown colour, much resembling chocolate, and are extremely 
fetid. But, should the liver itself be much affected, the feces 
may become of a yellowish white, or pus -like. 

1351. In the commencement of this complaint, or during what 
we have termed its acute or sub-acute form, we believe that the 
stomach and the smaller intestines are alone deranged; and, 
hence, when this disease is taken early, and properly treated, 
it is easily controlled. But, if the exciting cause be continued, 
and the complaint injudiciously treated, the liver, from its strong 
and constant sympathy with the stomach and bowels, becomes 
involved; and when this happens, the disease becomes more 
severe in its symptoms, and more permanent in its duration — it 
then constitutes diarrhoea in its chronic form. 

1352. The bowels may now be urged to severer duties by the 
presence of a greater quantity of bile; and the very irritation 
arising from this cause serves both to augment and perpetuate 
the secretion, by the liver sympathizing with the over stimulated 
bowels; so that they reciprocally injure each other. Or, the 
same effects may follow, and doubtless do sometimes, when the 
quantity of bile is not augmented, but altered in its quality; or 
neither, perhaps, need be required in some instances, provided 



350 OF DIARRHOEA . 

the mucous coat of the intestine be inflamed — a circumstance 
known to occur, by post mortem examinations. 

1353. It may be asked, how is it, if bile be not altered in its 
quality, that it should produce inconvenience to parts over which, 
in the best health, it constantly flows ? There is a law of the 
system which satisfactorily explains this — which is, that secre- 
tions do not injure parts over which they flow, as long as these 
parts remain sound or healthy; but if they are injured in any 
way, then these secretions become causes of irritation, and even 
of inflammation. Thus it happens with the bowels : in a healthy 
condition they receive from the bile a healthy stimulus ; but if, 
from any cause, they become irritated, as in the chronic form of 
diarrhoea, their natural stimulus, the bile, may, from their altered 
condition, become a source of serious mischief. 

1354. When this complaint has run on for a long time, espe- 
cially in children who have been weaned, and have suffered di- 
rectly from the change of diet, the mesenteric glands are some- 
times found inflamed, and enlarged; but this is by no means 
constant. We have seen death from this complaint, where, upon 
examination, no injury was found to have been sustained by the 
mesenteric glands. At other times, we have seen them an entire 
mass of disease. 

1355. Dr. Cheyne asks, "May not this (the enlargement of 
the mesenteric glands) proceed from the acrid nature of the ali- 
mentary matter, to which their absorbing mouths are exposed?" 
(p. 27.) We believe this to be the fact; and that their swelling, 
or becoming inflamed, was an effort to arrest the farther progress 
of this acrid substance, as a bubo does the venereal poison. 

1356. Dr. Cheyne, after having stated his opinion, as just 
noticed, that a morbid condition of the liver and its secretions 
may be the cause of "weaning brash," very modestly declares 
himself afraid of attempting an explanation of the phenomena. 
He, however, proceeds to do it in the following manner :— 

1357. "The breast milk is a mild food, adapted to the powers 
of the child ; I shall not say, the weak powers of digestion in 
the child; but rather to the peculiar powers and properties of 
the secretions. When the child is weaned abruptly, and put 
upon common food, this becomes too violent a stimulus to the 
intestines. Between the liver and intestines there is the most 
intimate relation. This excited state of the intestines causes a 
discharge of bile into them, which increases the stimulus and 
assists in maintaining the purging. Had the original cause been 
accidental and transitory, the bile, like the operation of a smart 
purge, would have thrown off the offensive matter and cured the 
complaint; but crude, unfit food, being still poured into the sto- 
mach, the disease must proceed. It is probable, therefore, that, 
in the first instance, a redundant secretion of the bile, which may 
also be an acrid and imperfect one, originating from an irritation 



OP DIARRH(EA. 351 

of the stomach, is a salutary exertion of the system to remove 
the cause of the irritation from the intestinal canal. But I think 
it likewise probable that the frequent repetition of this effort 
brings the liver into such a state that it cannot return to the 
performance of its ordinary and natural function when the 
demand for its unusual action ceases; and it is in this manner 
that the disease may continue, after the original stimuli have 
been removed, by putting the child upon a proper diet." 

1358. "The dejections are sometimes ochery, or even clay- 
coloured, which does not seem to favour the idea of a redundant 
secretion of bile. However, they continue pale but a short time, 
and soon resume the thin consistence, with their dark colour. 
The explanation of this, I presume to be, that during this interval 
the spasmodic contraction may have seized the duodenum at that 
part where the common duct emulges the bile into the intestines. 
And, farther, I presume the intestines have now become so irri- 
table that they are stimulated to inordinate action by the aliment, 
even at the time when, from the supposed stricture of the duct, 
the bile may be deficient; and hence the griping pain still con- 
tinues." 

1359. "But it may be, and most probably is, in the ducts, 
that the explanation of this irregularity, in a great measure, is 
to be looked for. I have, upon dissection, found the bile col- 
lected in such quantity in the gall-bladder that this accumula- 
tion became the cause of the confinement of the bile ; for then 
the natural curve which the cystic duct takes becomes so acute, 
and the distended bladder presses so much upon it, that the bile 
is prevented from flowing, or flows in very small quantity. By 
this retention the bile becomes more concentrated, and thence, 
perhaps, more acrid. And, finally, by some action of the sto- 
mach and duodenum, by which the very enlarged gall-bladder is 
compressed, part of its contents is forced out ; the distended 
ducts are relieved, and the intestinal canal is inundated with 
bile." (p. 24.) 

1360. Dr. Cheyne farther observes: "Notwithstanding my 
most diligent inquiries, I have seldom been able to deduce any 
of the derangements of the infantile system from teething ; and 
I have been inclined to think that those physicians who have 
represented this function as teeming with danger, have not ac- 
customed themselves to that careful investigation without which 
these diseases cannot be understood. The weaning brash, I 
have the strongest reason to believe, has no connexion with 
teething, farther than they sometimes meet in the same child. — 
I have known this disease in many instances where the gums 
were neither swelled, indurated, nor inflamed, and where there 
was no salivation, northe least appearance of pain inthemouth. 
I have seen it where children were cutting their teeth easily : 



352 OF DIARRIKEA. 

and where many of them came without difficulty before wean- 
ing; still the disease has supervened. But perhaps the strong- 
est argument that can be used would arise from the observation 
which I have frequently made, that this disease occurs in chil- 
dren of three months ; and I have often known it several months 
before teething came on." 

1361. We have already expressed our belief, (p. 282,) that 
teething in itself is no disease ; but that in many instances it 
either calls into action some latent disposition to disease, or ag- 
gravates any that might be present during the continuance of 
that process. If teething were a disease, strictly speaking, it 
would be more uniform in its consequences, or present pheno- 
mena peculiar to itself; but this it does not always do; for 
we have many times known teeth to make their appearance long 
before the ordinary period, and when they were not announced 
by any one of the usual phenomena. We have also known them 
make their way so silently, and this about the period at which 
they might be looked for, that the only knowledge of their ap- 
proach was their presence. All this we say in confirmation of 
Dr. Cheyne's observation. 

1362. But, on the other hand, we are equally certain that 
the process of teething disturbs the system under particular 
circumstances, and that sometimes very powerfully, by calling 
into action certain dispositions which cannot very well be sub- 
dued until the disturbance in the gums, or the local, or teething 
irritation, if you please, has been either moderated or subdued. 
Therefore, when this subject is looked at in a practical point of 
view, it must be considered almost a dispute about words ; for 
whether the act of teething be a disease in itself, or whether it 
excite those which are latent, or exalt those which may be pre- 
sent, we must regard the circumstance of teething as one well 
meriting the attention of the practitioner : and, farther, if he 
disregard the practical hints this operation aifords him, we fear 
he will often protract the sufferings of his little patient, or some- 
times even witness its death. 

1363. In the disease in question we are certain that the most 
decided and prompt benefit has arisen from incising the gums ; 
and when the teeth are really aggravating the complaint, it is 
in vain we prescribe remedies, unless we remove this source of 
irritation from the constitution, by aiding nature to push these 
bodies through the irritated or inflamed gums. We do not mean 
this literally ; for we have before observed that two processes 
were going on to effect what is called cutting teeth : namely, 
absorption, and the mechanical enlargement and pressure of 
the tooth itself ; for did not both contribute to this end, the 
state of the gum would remain stationary, at least for a very 
long time. We must, therefore, very often regard cutting the 
gums as one of the remedies proper in the " weaning brash." 



OF DIARRHCEA. 353 

1364. For the prevention of " weaning brash," Dr. Cheyne 
advises, that, as this disease appears " much oftener in the au- 
tumn than at any other time of the year, delicate children 
should at that season he kept a month or two longer at the breast 
than might be thought necessary at any other, rather than be 
exposed to the pains and hazards which never fail to accompany 
this distemper," (p. 33.) 

1365. This advice is in strict conformity to the usage of this 
country: it is so well understood by every body here, that a 
physician is rarely consulted about its propriety. During the 
months of June, July, August, and frequently September, 
weaning is never performed as a matter of choice, let the age 
of the child be ever so proper, unless it have completed the cut- 
ting of its first set of teeth. The dread of our females, in this 
country, is the "second summer." 

1366. iSo fact appears to be better ascertained, than that 
the "second summer" is one of severe suffering, and of- 
tentimes one of great hazard to our infant population. Eve- 
ry mother seems to be aware of the disposition of the bowels 
to become diseased at this period of the child's life ; but she 
limits the apprehension, almost exclusively, to the consequence 
of " teething." We have already declared our belief in the 
agency of the act, when untoward, in the production or aggra- 
vation of the complaints of the bowels : but this is only one 
of the sources of evil to the poor weaned child at this period — 
the change of diet immediately after this has taken place, as has 
already been observed, is another. 

1367. Keeping the child, then, at the breast during the months 
of the second year, as above specified, is most decidedly, but 
tacitly acknowledging the influence of the long-continued ope- 
ration of a hot sun upon the tender system of children, rather than 
proving the direct agency of teething in producing their bowel 
complaints; since they are during the first summer, at those 
periods of greatest heat, very liable to diarrhoea, though this 
disease may be, and but too often is, aggravated in the second 
year by the process of teething. 

1368. Our long summer heats generate "disposition" to dis- 
ease, in both the hepatic and intestinal systems ; and, of course, 
require, at such periods, but slight exciting causes to arouse them 
into action ; and these causes, unfortunately, are so numerous, 
and of such certain application, as to give the child, in its "se- 
cond summer," but a poor chance to escape with impunity. Our 
children are tempted at this period of their lives, and at this hot 
season of the year, by the offering of fruit in every stage of 
immaturity ; or of an over quantity of that which may be perfect. 
They are liable to receive from the hands of but too many in- 
considerate people food of the most improper and indigestible 

23 



354 OF DIARRHCEA. 

kind; and at the same time they are menaced with all the "pe- 
nalties" of difficult dentition : can it then be a matter of surprise, 
that, at this period, they should be assailed by disease, or that 
they should succumb under its influence? 

1369. It is confirmed, by multiplied observation, that at no 
other periods of the year is there the same risk in weaning, as 
in the commencement and at the termination of our summers ; 
and this from the causes we have just mentioned: they are, 
therefore, eschewed with the utmost care, when there is a choice 
upon the subject. Is this not a farther proof that the effect of 
season is more to be dreaded than the mere process of dentition ? 
since, at other portions of the year, weaning may take place 
with impunity, if the organs of digestion be sufficiently confirmed 
by age to bear a change of diet, though teeth may be pretty 
rapidly pushing through the gums ? Again ; it is a fact perfectly 
well known, that children are born in every day of the year, 
consequently, they must cut their teeth at every period of the 
year; yet, but one part of this time is considered dangerous for 
this operation; and the supposed direct consequence of this act, 
namely, diarrhoea, is familiarly called the "summer complaint 
of children!" It, therefore, only amounts to what we have 
already attempted to prove, that teething is but the exciting 
cause of diarrhoea. 

1370. To diminish the risk at this period of life, the remote 
and the exciting causes of diarrhoea, or "weaning brash," must 
be as far as possible avoided. 1st, Of the remote causes. The 
utmost attention should be paid to the clothing of the child, (see 
Book I. p., 74, par. 226,) that it may not suffer from either an 
excess or deficiency of it; 2dly, it must be protected against 
the chilling effects of a damp and cold atmosphere, by removing 
it from it, when practicable, as in certain locations ; prohibiting 
its exposure to the dews of the evening, or to the fogs and dews 
of the morning ; to forbid, or rather to prevent, the injudicious 
use of the cold bath, &c. ; 3dly, to guard against the direct ef- 
fects of heat, by not exposing it to the hot sun, and to the too 
cool shade, after such exposure. 

1371. 2. Of the exciting causes. By being vigilant that the 
child may not receive injury from improper food ; as crude fruit, 
indigestible meats or vegetables; 2dly, that the child be not 
nursed immediately after the mother or nurse has been over- 
heated, or recovering from a fit of anger, or any convulsive 
action of the system ; nor to persevere in the use of the milk of 
the breast, after evidence has been exhibited of its being of bad 
quality, either from its age, its imperfect elaboration, or the 
return of the catamenial discharge ; 3dly, to remove the irritation 
of teething, when this manifestly arises from the condition of 



OF D I A RR Il'<E A . 355 

the gums, by freely, and sometimes repeatedly, lancing them; 1 
4thly, by protracting the period of weaning until some time after 
the forbidden months, (638 ;) 5thly, by not weaning at too early 
a period of the child's life, though the season of the year be 
proper ; 6thly, by gradually accustoming the child to a change 
of proper diet, provided it have a sufficient number of teeth for 
this purpose. (See Book L, par. 692, et seq.) where we have 
sufficiently explained our views upon this point. 

1372. We firmly believe that, were these directions strictly 
complied with, it would rarely happen that children would be 
afflicted with diarrhoea, in either its acute or chronic form. We 
believe this, because we have more than once witnessed an entire 
exemption from diseases of this kind, even in large families, 
where strict attention has been paid to these points. 

Sect. VIL — Of the Treatment of Chronic Diarrhcea, or " Wean- 
ing Brash*" 

1373. Every body has experienced the difficulty of removing 
a diarrhoea, after it has taken a chronic form. This arises from 
several causes: 1st, because the hepatic system is now involved 
with the intestinal, (1278 and 1349,) in maintaining this com- 
plaint; 2dly, because the stomach and bowels, independently 
of the condition of the liver, are seriously affected by either in- 
flammation, (1346,) ulcerations, contractions, or intus-suscep- 
tions ; 3dly, because, very often, the irritation is maintained by 
the presence of worms, which are sometimes difficult to dislodge ; 
4thly, because the influence of habit is added to the original dis- 
position to too frequent dejections. 

1374. When the first cause of difficulty alone prevails, the 
disease, for the most part, is of pretty easy management: the 
symptoms here may consist of too frequent discharges, of a green, 
slimy, or curdled appearance ; with loss of appetite, nausea, and 
sometimes vomiting, and of increasing emaciation; the skin al- 
most always dry, and very warm where covered; the urine 
scanty, and high-coloured; the thirst great; and the disposition 
fretful, whimsical, or sluggish. 

1375. Three indications here present themselves : 1st, to alter 
the nature of the actions of the stomach, bowels and liver; 2dly, 
to abate the frequency of the discharges ; and, 3dly, to restore 
the lost strength of the parts immediately concerned, and the 
system in general. 

1376. The first indication must be fulfilled by freely emptying 

1 By this we do not mean to advise the cutting of an individual tooth more than 
once, provided it have been properly done once ; by properly done, we mean tbat 
the tooth be felt, and cut down on by the lancet, by which the resisting membrane 
is incised, and it then never again unites to annoy. 



356 OF DIARRIKEA, 

the bowels by castor oil, rhubarb or calomel, and then by giving 
small doses of calomel; that is, from a quarter to half a grain, 
morning and evening, with three grains of prepared chalk, and 
from a tenth to a twentieth of a grain of opium, according to 
the age of the patient. The second must be attempted, either 
by rhubarb, or the cretaceous mixture: by rhubarb, during the 
day, in the form of syrup, taken every three hours, in the 
dose of a tea-spoonful, or half a tea-spoonful, with half a drop 
or a drop of laudanum, according to the age of the child, the 
degree of pain, or as the motion of the bowels may be more or 
less frequent ; always proportioning the quantity of the laudanum, 
and the frequency of its exhibition, to the exigencies mentioned. 
At night, a sufficient quantity of laudanum by the mouth, or by 
injection, should be given, to keep the bowels quiet until the 
morning. 

1377. By the cretaceous mixture, when there is evidence of a 
prevailing acid in the evacuations. This may be known, 1st, 
by the green being light, and the evacuations watery; 2dly, by 
the smell; 3dly, by the appearance of portions of hard curd 
among the feces; 4thly, by the discharges becoming greener by 
standing; Sthly, by the matter vomited, should vomiting attend, 
smelling sour, and the milk coming up in strong curd; 6thly, by 
a dense white coat upon the tongue, which is a stratum of milk 
coagulum. 

1378. The best form of giving the mixture is as follows: — 

R. 



Creta. ppt. 


3iij- 


Tinct. Thebaic. 


gut. xx. vel xxx. 


01. Cinnam. 


gut. j. 


Sacch. Alb. 


3ij- 


Aq. font. 


giij. M. f. Julap. 



A tea-spoonful of this must be given every two, three or four 
hours, as it may influence the motions of the bowels. Where 
the motion of the bowels is kept up by acidity, the effect of this 
remedy is sometimes so prompt that two or three doses will en- 
tirely suspend the discharges — therefore, wherever this effect is 
observed, the medicine should be suspended until the recurrence 
of a fresh necessity. 

1379. If it do not show this decided control over the motions 
of the bowels, it will, nevertheless, if the greenness of the eva- 
cuations depend upon an acid, very much abate their frequency, 
and change their green appearance to yellow; but should it de- 
pend upon bile, it will have little or no effect. It may be per- 
severed in, as necessity may require. But we always feel it im- 
portant, in such cases, to tranquillize the bowels, during the 
night, by a suitable dose of laudanum. 

1380. Should, however, the motions of the bowels be too long 
arrested, that is, beyond eight or ten hours, an injection of mo- 



OF DIARRIKEA. 357 

lasses and water, or flax-seed tea, should be given; and, if ne- 
cessary, it may be rendered more stimulating by the addition 
of a little salt. In this way, the motions may be kept in sub- 
jection, or rendered obedient to the wishes of the physician. 
During the whole of the time the most particular care must be 
paid to the diet and drinks of the patient. 

1381. Nothing heating or stimulating should be given, either 
as nourishment or as drink ; and every species of liquor, animal 
food or broth, must be prohibited, if there be the slightest evi- 
dence of fever. The diet must consist only of such articles as 
the stomach can best manage, as milk and water, gum Arabic 
and water, very thin arrowroot, sago, or tapioca, rennet whey, 
barley water, or rice water. Nothing solid of any kind should 
be given. The occasional use of melted butter is found often- 
times highly advantageous in almost every state of chronic diar- 
rhoea; but is especially so where there is a predominance of 
acid, and where there are sparing stools, accompanied by hard 
curd, and a whitish mucus from the bowels tinged with blood. 
It is made by pouring boiling water upon a lump of perfectly 
sweet butter in a tea-cup, and stirring it until it is melted; a 
tea-spoonful is skimmed from the top, and given several times 
a day. 

1382. It may be well to observe that during the period in 
which too much acid prevails, but a very small quantity of milk 
should be used, unless it be reduced by lime-water — in this state 
of combination it may be given ; or, if there be but very little 
fever, or none, chicken or beef tea may be used, instead of the 
vegetable jellies above mentioned; with the exception, perhaps, 
of the gum Arabic water. We are in the habit of continuing 
this mucilage throughout the complaint, where it does not dis- 
agree, or where the child does not refuse it. 

1383. The third indication may be fulfilled by the proper use 
of diet — permitting the use of weak broths, without vegetables 
being boiled in them, with the exception of rice; but even this 
must be strained from them before they are given. A soft-boiled 
fresh egg may after awhile be given; a portion of ham may be 
sucked; or a little well-boiled rice, with sugar, very fresh butter, 
and a little nutmeg, may be made to follow from time to time. 

1384. But if the child be weaned, nothing will so certainly 
contribute to its recovery, as its restoration to the breast, when 
practicable; or, if the child be at the breast, and there is room 
to suspect the quality of the milk, a fresh nurse should be im- 
mediately procured. Should the teeth be in fault, the gums 
should be freely cut. Suitable exercise must be instituted; and, 
when practicable, the child should be sent to the country for the 
benefit of a change of air. 

1385. Where the second condition (1373) obtains, the disease 



358 OF DIARRHOEA. 

must be considered not only very far advanced, but highly dan- 
gerous ; for it must not be concealed that more or less danger 
must attend an inflammation of the mucous membrane of the in- 
testines. Have we any certain marks to distinguish this condi- 
tion of the bowels? It may be suspected where the pulse is 
very much accelerated; where the child is extremely restless, 
drawing up its feet and thighs towards the abdomen ; crying 
loudly, or moaning frequently; if pain be increased by pressure 
upon the abdomen ; if the skin be hot and parched ; if the evacu- 
ations be extremely frequent; a disposition to tenesmus; if the 
evacuations be sparing, slimy, or bloody, though frequent ; if the 
thirst be excessive; and the tongue dry, red, and tender. All 
these symptoms, or the greater part of them, may attend an in- 
flammation of the mucous tissue of the intestines. 

1386. The indications here are, 1st, to abate the local inflam- 
mation ; 2dly, to change the nature of the secretions of the liver 
and bowels, and to allay the irritation of the intestines ; 3dly, to 
diminish the frequency of the discharges ; and, 4thly, to restore 
lost strength. 

1387. The first indication must be attempted to be fulfilled 
by local depletion, by leeches, 1 by the occasional use of the warm 
bath ; by blisters on the abdomen or thighs. The second, by the 
exhibition of the calomel in alternate doses; and by small but 
repeated doses of castor oil. The third, by the occasional use 
of laudanum enemata, when they can be retained; or by its ex- 
hibition in small but repeated doses by the mouth. And the 
fourth by proper diet, as above proposed ; by exercise ; and by 
removal to the country. 

1388. In this, and in the subsequent stage, it may be proper 
to observe, that nothing but rennet whey, or weak gum Arabic 
water, should be given as nourishment, and even these in but 
very small quantities. 2 The thirst is best slaked by a tea-spoonful 
of cold water, given from time to time. 

1389. When this disease is still more advanced, and has been 
of long continuance, we have a right to suspect, what has been 

x Five or six applied around or near the umbilicus. Should they seem disposed 
to continue to bleed, they ought to be stopped as quickly as possible by a solution 
of the sulphate of copper, nitrate of silver, or spunk ; or if these fail, we are told 
that finely powdered secale cornutum, spurred rye, is very effectual : it deserves 
a trial. 

2 We are persuaded that one of the most operative causes against the recovery, 
in every bowel complaint, is the too frequent exhibition of food, both proper and 
improper; especially during its active stage. The fear of weakness leads inces- 
santly into error on this subject ; and neither reason nor experience is capable of 
destroying this absurd and dangerous practice. Every body would at once ac- 
knowledge it to be not only preposterous, but even cruel, to place an additional 
weight upon the shoulders of a man who was staggering under the load already 
laid upon them ; but they would think it right to do what is equally absurd and 
cruel to the stomach, by forcing upon it a fresh quantity of food, when it had not 
power to dispose of that which it had previously received. 



OF DIARRHCEA. 359 

but too often proved by dissection to happen under such circum- 
stances, contractions, ulcerations, and intus-susceptions. We 
have no diagnostic symptoms for these conditions of the bowels ; 
and, if we had, it might be justly doubted whether the knowledge 
of them would lead to any valuable practical end with our pre- 
sent dearth of proper remedies. We fear that, in these cases, 
no other plan can be pursued but a temporizing one ; for it is to be 
presumed that every effort has been made during the previous 
stages of the disease, to arrest its progress. Therefore, we need 
but rarely flatter ourselves with the hope of a recovery, where 
the emaciation and weakness are extreme; where nothing, or 
next to nothing, can be retained upon the stomach; where the 
abdomen becomes tympanitic; where there is almost a total stop- 
page of the secretion of urine; and where the stools are ex- 
tremely offensive, dark brown, large in quantity, and mixed with 
either blood or puriform matter, or both ; and, above all, when 
these are very frequently and involuntarily discharged. 

1390. We have frequently known the bowels to continue to be 
purged, and that for a long time, by the presence of worms in 
the alimentary canal. We always suspect this cause when the 
complaint has resisted the usual remedies; where the teeth can- 
not be in fault ; where there is no appearance of bile, and espe- 
cially when the stools are of a dark brown colour, very thin and 
very offensive. The child, also, may have a tumid belly ; a strong 
or offensive breath; a furred tongue; a voracious or diminished 
appetite ; itching of the nose, and sometimes regular febrile pa- 
roxysms. 

1391. We, in such cases, treat the disease as a worm case ; 
either by pink-root, worm-seed oil or calomel. We always give 
a decided preference to the first remedy, where it is practicable 
to get the child to take it. And we may almost always succeed 
in doing this, with children who are of sufficient age to sit at 
table, and who are in the habit of drinking coffee, by using the 
pink-root in the following manner : — 

1392. Take the proper quantity of pink-root, 1 and pour upon 
it about half a pint of pretty strong boiling coffee, and permit 
it to draw — pour off one-half into a cup, sweeten it, and put milk 
or cream in it, and give it to the child, as if it were pure coffee, 
(for it is not to be informed it is not:) it will drink this almost 
always without the slightest hesitation. It will receive the other 
half at tea-time, managed as before. This must be repeated for 
three days, consecutively: on the fourth, should the bowels not 
be opened, (for it almost always stops the discharge in this 

* The dose of this article may be from a quarter of an ounce to half an ounce. 
The first quantity will do for children from ten months to a year ; one-third of 
an ounce, from this time to two years; half an ounce from this period to seven 
years old. 



360 OF DIARRH(EA. 

period,) let the child have a dose of castor oil, or a few grains of 
calomel. 

1393. It must be observed we have seen a stop put to a diar- 
rhoea of very long standing by a few doses of pink-root, and this, 
sometimes, without any ocular proof that worms were the cause 
of it — we have, therefore, for many years past, made it a rule 
to exhibit this remedy, when the complaint has resisted the or- 
dinary means. 

1394. If the pink-root cannot be given, the worm-seed oil may 
be substituted, 1 but it is by no means so certain. If neither can 
be given, or if there be too much fever for the worm-seed oil 
(for it should never be given at that time,) the calomel may be 
used, and sometimes with the most prompt and decided advan- 
tage. 

1395. The following case, which has lately been under our 
care, will illustrate this practice very well. A child of C. E. C. 
was weaned at four months, in consequence of the illness of the 
mother. It was, however, very well nourished by the bottle ; it 
throve well, and had several teeth before it was seven months 
old. It was attacked in the month of June with the bowel com- 
plaint of the ordinary kind, from which it was pretty speedily 
relieved by calomel, &c. In July it had a return of this com- 
plaint, with more violence than formerly; owing, it was supposed, 
to several teeth that were making their appearance. 

1396. The gums were considerably swelled and inflamed; 
and the child slavered very freely. Its lax was very profuse, 
but the stools were of a good colour. The teeth were liberated 
by lancing the gums ; the diarrhoea abated by the use of calomel, 
syrup of rhubarb, and a testaceous mixture, and the child sent 
to the country to recruit. About a fortnight after it had been 
there, the bowel complaint returned with considerable severity ; 
its evacuations were very frequent, bilious and offensive. The 
former remedies were again tried, but not with the former suc- 
cess. The child began to emaciate ; to become sick at the sto- 
mach, voiding green, acrid and watery stools. By the use of 
absorbents, and very small doses of calomel, he was again relieved; 
but this was but for a short time. 

1397. The bowel complaint became now very severe; the belly 
was much enlarged ; the urine nearly suppressed ; the child very 
languid and fretful ; its food would frequently pass through it 
without change ; it would almost every day have a kind of spasm 
in all the muscles of the body, which would last sometimes for 
many minutes together, and these would be repeated three or 
four times a day. A regular paroxysm of fever established itself 
at six o'clock every evening, which would terminate next morn- 

1 There are printed directions for its use, accompanying each bottle of the oil. 



OF DIARRHOEA. 361 

ing in a profuse perspiration ; the child was incessantly picking 
its nose, "was very fretful and whimsical; appetite sometimes 
good, at others would refuse every thing. When the febrile 
paroxysm was off, the pulse was pretty natural; its tongue was 
much loaded, and its mouth studded with many little painful 
pimples and ulcerations ; a great quantity of very tenacious trans- 
parent saliva flowed constantly, even to annoyance. The child 
was now turned of ten months, and had ten teeth ; the gums 
were carefully examined, but there was no swelling of them to 
lead to the suspicion that dentition was the cause of the symp- 
toms. 

1398. Believing there were worms in the case, knowing the 
impossibility of giving the pink-root, and the system was not in 
a situation to receive the worm-seed oil, we determined on the 
use of small but frequently repeated doses of calomel, as in the 
following formula : — 

R. Calom. ppt. gr. iij. 

Creta. ppt. 9j. 

Gum. opii. gr. ss. 

M. div. in xij. parts. 

1399. One of these was ordered to be given every two hours, 
until bed-time, at which time six drops of laudanum were to be 
taken. On our visit the next morning, we learnt the child had 
passed two worms, and was evidently much relieved. 1 The bowels 
were much less frequently moved. The powders were ordered 
to be continued. The medicine operated pretty freely the next 
day — brought away nothing very remarkable, except dark green 
slimy bile. The powders were continued, and we were informed 
the day after, (being indisposed, did not see the child,) that the 
child had passed, the previous night, a knot of worms of the size 
of a nutmeg. This was all the information we received but that 
the child was very well. 

1400. Habit sometimes perpetuates the discharges from the 
bowels : this cause may be suspected when the evacuations occur 
at nearly stated periods of the day; when they are not continued 
through the night, and when the digestion goes on well, and the 
stools look natural. Children, from the long continuance of 

'The character of these worms, as far as we could judge of them in their muti- 
lated state, was altogether different from any we have seen ; and entirely different 
from each other. We regret that sufficient care had not been taken of them, to 
prevent injury. One was about double the length of the other; it was of a dark 
brown colour, broader at the tail extremity than at the head. It was seen, by the 
acid of a strong glass, that the head was of a triangular form, and evidently had 
two osculi. The body was so much injured by compression that we can say nothing 
certain about it. The other was about four inches in length, of equal thickness 
throughout; of a pale yellowish red, transverse lines very near each other through 
the exrent of the body; the position of the mouth appeared to be transverse, and 
the head obtuse and round. 



362 OF CHOLERA INFANTUM. 

diarrhoea, and those of sufficient age to feel a sense of shame, 
and especially those who have been schooled into good habits in 
regard to their evacuations, are always sure to obey the first 
impulse or warning the bowels give, that a discharge is about to 
take place, and by this means, no doubt, have provoked an 
evacuation, which a little self-command might have checked. 
By this means almost all influence over the sphincter is lost, and 
the discharge is maintained from habit. 

1401. Laudanum we have found the best remedy for this kind 
of diarrhoea, especially when combined with prepared chalk ; it 
should be given as frequently as the state of the bowels would 
seem to require — that is, given immediately after each evacuation, 
and telling such as can comprehend the instruction, not to obey 
the desire as long as they can possibly resist it. 



CHAPTER XXVIII. 



OF CHOLERA INFANTUM. 



1402. This is a disease almost peculiar to the climate of the 
United States; and, indeed, we might say it is limited very much 
to the middle and southern states. Children, in other countries, 
seem to be exempt from this, but on the other hand are obnox- 
ious, during dentition, or from other causes, to various affections 
of the alimentary canal, all of which differ from our endemic. 

1403. The exciting causes are, improprieties in diet and too 
thin clothing; and it is, likewise, very often aggravated by teeth- 
ing, worms, by premature weaning, and by a variety of adventi- 
tious circumstances. 

1404. Cholera infantum makes its approaches in different 
ways. In some instances it comes on as a simple diarrhoea, though 
the stomach is also very apt to be affected ; and in its more vio- 
lent forms there are vomitings and purgings, attended by no 
considerable spasmodic uneasiness, constituting the cholera mor- 
bus of farther advanced life. In its ordinary forms, the fever, 
which soon supervenes, is of an irregular remittent character ; 
the exacerbations being highest in the evening. The pulse is 
usually small, quick, and feeble, or irritated and corded; but 
rarely full, strong, or voluminous. Determinations to the brain, 
or, at least, this organ seems early to be affected sympathetically ; 
as is manifested by a tendency to stupor or delirium, or some- 
times even phrensy. The eyes, also, denote this cerebral affec- 
tion : they are either fierce or languid in expression ; and when 



OF CHOLERA INFANTUM. 363 

the patient sleeps, are half closed. Thirst is intense, and for a 
time really unquenchable — cold water is clamorously demanded, 
but if swallowed is instantly rejected. 1 An unequal distribution 
of temperature commonly exists ; the head and region of the 
stomach and bowels being hot, while the extremities are cold. 

1405. The appearances of the evacuations from the bowels 
are various. The natural faeces are mostly retained, though oc- 
casionally small lumps may be found involved in the other dis- 
charges. These are sometimes thin and watery; and at other 
times thicker and more tenacious; consisting chiefly of slime, 
or mucus occasionally tinged with blood. The colour may be 
green, or yellow, or white, or brown ; and may be inodorous, or 
exceedingly offensive. Commonly, however, the smell is that of 
sourness, or of putridity. The irritability of the alimentary 
canal is sometimes so great that the ingesta rapidly pass off un- 
altered, as in lientery. 

1406. We have few diseases in which emaciation of the pa- 
tient so rapidly takes place, or where, in its later stages, there 
is a greater alteration of general condition and aspect. The 
child, at first, becomes pallid, and the flesh flabby ; and, so com- 
pletely is the fat ultimately absorbed, that the integuments hang 
in folds; and in those parts on which the body rests, livid spots 
appear, followed by ulcerations. 

1407. The skin on the forehead is tight, as if bound to the 
bone; the eyes are sunk; the cheeks fall in; the nose is sharp ; 
and the lips are shrivelled. Even under such circumstances as 
would seem to denote immediate dissolution, life will, in some 

'We are, however, disposed to believe this would not so generally happen 
were this article more judiciously administered than it usually is. From the 
vehemence with which drink is seized by the little sufferer, it is evident how 
severe the thirst must be : to relieve this, water is given to it in full draughts, 
and is sometimes violently rejected before the last portion has arrived at the sto- 
mach. 

The child instantly renews its supplications for drink; and this with a counte- 
nance so beseeching, and a manner so earnest, that no resolution, scarcely, can 
resist the appeal, though there may be the most perfect conviction of its mis- 
chievous tendency. Again it is presented, again it is swallowed, and again it is 
thrown up — and so it would proceed, were the demands- constantly supplied, to an 
indefinite period. 

Much resolution is required, for much firmness must be exercised, not to comply 
with these insatiable demands; or, at least, to the extent that would satisfy the 
craving and anxious child. But its vehemence may be amused, if not absolutely 
diminished, by exhibiting the water by tea-spoonsful, and this as warm as it can 
well swallow it; for such is its desire for something fluid, that it will swallow 
the hot water as readily as the cold ; or, if it like it less, it will sometimes be less 
importunate in its demands. 

We have several times seen the most prompt advantage result from exhibiting 
to the little sufferer very small pieces of ice, every few minutes. This is most 
grateful as well as useful. It seems more certainly to abate thirst, and at the 
same time tranquillizes the stomach better than water : on this account it always 
deserves a trial with children of sufficient age not to be injured by its being re- 
ceived in its mouth, at the risk of getting into the windpipe. 



364 OF CHOLERA INFANTUM. 

cases, be preserved for weeks, and a recovery finally take place. 
The belly becomes tumid from flatulence; the feet still more 
frequently are cedematous ; aphthre appear; the mind, as well 
as the senses, which hitherto may not have been impaired, are 
now obtuse, or so entirely lost, that the child lies unmoved by 
ordinary excitements, and will even allow flies to collect on the 
face without being irritated or disturbed. This form of the dis- 
ease will sometimes continue for five or six weeks. But as death 
approaches, a gradual aggravation of symptoms takes place ; and 
there is one, which, as far as we have observed, has always proved 
fatal f it is a crystalline eruption upon the chest, of an immen- 
sity of watery vesicles, of a very minute size. The best idea 
we can convey of the appearance of this eruption, is to imagine 
a vast collection of vesicles, apparently produced by flirting an 
equal number of very minute drops or particles* of boiling water, 
and each particle producing its vesicle. We first pointed out 
this appearance to our friend Dr. Physick, in the year 1794, in 
the disease now under consideration; and subsequently, under 
like circumstances, to Dr. Rush; both of whom acknowledged 
the eruption was new to them. 

1408. This symptom may readily escape observation, if not 
looked for: it requires that the surface on which it has spread 
itself should be placed between the eye and the light, and viewed 
nearly horizontally. 

1409. There is another symptom which attends the last stage 
of this complaint, which is much more common, but not less 
fatal ; which is the thrusting of the fingers, nay almost the hand, 
into the back part of the mouth, as if desirous of removing some- 
thing from the throat. The popular opinion is, that there is a 
worm irritating the back part of the fauces. And we may men- 
tion another, which we do not remember to have seen noticed, 
which is, the escape of a live worm or worms in the chronic stage 
of this affection. If the worm come away dead, there is nothing 
in the circumstance; but if alive, it is a fatal sign. We have 
remarked the same in dysentery. 

1410. In other cases, however, especially where this epidemic 
puts on the character of cholera morbus, or dysentery, its pro- 
gress is more rapid, and runs, in all respects, the course of these 
affections. Death, in the former of these instances, will some- 
times take place in a few hours ; and, in the latter, from three 
to ten, or fifteen days. 

1411. The symptoms of this disease are so peculiar, and so 
well defined in the genuine forms, that it will always be recog- 

1 A few months since, we saw this eruption on the chest in a lad of eighteen, 
to whom our friend, Dr. Hays, called us in consultation. In this case, recovery 
took place after a very long and severe struggle j the original complaint was fe- 
ver, with hemorrhage from the bowels. 



OF CHOLERA INFANTUM. 365 

nised without difficulty; therefore, we need not dwell upon its 
diagnostics. And, where it imitates other affections, as cholera 
morbus, or dysentery, or diarrhoea, it may be considered as es- 
sentially such, requiring no difference of treatment. Cases most 
resembling it are some of those brought on by the irritation of 
teething. Even here, however, the treatment is analogous, so 
that no nicety of discrimination is required; though there are 
circumstances in the season of the year, the wide spreading of 
cholera infantum, independently of symptoms, which will enable 
us to do it. 

1412. The prognosis is far more difficult, since death some- 
times happens most unexpectedly ; and recoveries take place in 
a state of things apparently desperate. In the most violent form 
of cholera morbus, it often proves suddenly fatal. But cholera 
infantum, in its ordinary forms, may be considered as doing well, 
where the pulse becomes slower, fuller and more natural ; where 
temperature is restored to the surface and equally diffused ; 
where the irritability of the stomach and bowels subsides ; and, 
above all, where the alvine discharges, previously denoting the 
want of bile, now consist of dark bilious, offensive or inodorous 
matter, or exhibit a more healthy aspect. Till this happen, or, 
in other words, unless the liver is restored to its natural func- 
tions, it may be laid down as an invariable rule that convales- 
cence does not take place. 

1413. An opposite prognostic may be made, or, at least, im- 
minent danger is to, be apprehended, where there is an absence 
of the favourable signs just enumerated; and, particularly, where, 
with a cold damp surface, there is a small thready pulse ; lank, 
haggard countenance; incessant puking of whatever is received; 
purging of a pink-coloured fluid, or of greasy fetid water, or of 
a dark flocculent matter, attended with extreme nervous sensi- 
bility, or an entire extinction of it; the child lying stupid, with 
its eyes half closed and deeply sunk, or with occasional convul- 
sions. 

1414. In protracted cases, the eye-balls become perfectly 
blood-shotten, mimicking a genuine inflammation, but it is no- 
thing but a case of pure error loci ; and must always be regarded 
as a bad, but not necessarily a fatal symptom. We have seen some 
few instances of recovery, after it had taken place. One who 
is not experienced in this disease may encourage hopes which 
can never be realized. At this period of the complaint, or 
rather just before its fatal termination, the eye sometimes has 
its brilliancy and vivacity renewed, after it had been a long time 
nearly extinct; the general symptoms seem to abate ; the child 
receives food, even greedily: and manifests an intelligence that 
truly astonishes. But the practised eye sees nothing in these 
changes but the immediate forerunners of death. 



366 OF CHOLERA INFANTUM. 

1415. Dissections clearly inform us of the seat and nature of 
cholera infantum. The brain presents no morbid appearances, 
now, except those of congestion; but in the protracted forms, 
eifusions are often met with, constituting hydrocephalus. 

1416. The viscera of the thorax are rarely affected. It is on 
the contents of the abdomen that it mainly expends its force. 
The effects of previous inflammation may be traced, in some 
cases, throughout the whole of the alimentary canal ; though it 
is in the mucous membrane that they are principally to be found. 
Dark livid spots are dispersed over this coat of the stomach, and 
of the small intestines, particularly the duodenum, near to the 
pylorus. Coagulable lymph is also, in some instances, spread 
on their surface, or is found in detached pieces. In many parts 
there is an alteration of structure, by the thickening of their 
parts ; so much so that the caliber of the tube is considerably 
lessened. 

1417. The large intestines are seldom involved in this mis- 
chief; and, perhaps, never, excepting where the disease has 
assumed the dysenteric form. Indeed we may say, when the 
larger intestines become inflamed, either as an original location, 
or inflammation from continuity, then we have dysentery added 
to the original disease. Now and then appearances similar to 
those of the primae vise, may be seen upon the peritoneum, 
though not to any extent. The liver, under almost all circum- 
stances, and especially in cases of long continuance, is greatly 
enlarged, so as sometimes to occupy two-fifths of the cavity of 
the abdomen. But, though thus increased, there is not any very 
evident derangement of structure. Indeed it is rather functional 
than organic. It is merely distended or swollen by congestion ; 
and, on this account, is more firm and solid, than natural — a 
state of things evidently induced by torpor in the portal circula- 
tion. The gall bladder, in some instances, is found filled with 
dark green bile, and, at other times, with that which is pale, or 
nearly colourless. 1 The other viscera of the abdomen are usu- 
ally healthy. It may, however, be proper to add, that the con- 
tents of the bowels, for the most part, consist of a thick, tena- 
cious mucus, involving small lumps of faecal matter, occasionally 
coloured by bile. When this disease causes death, by assuming 
a chronic form, it very much resembles the chronic form of diar- 
rhoea, or weaning brash. 

Treatment . 

1418. The disease, as already stated, usually commences with 
a very disordered state of the alimentary canal ; and it seems 

1 We have, in two or three instances, seen the gall-bladder filled with a fluid 
nearly as white as serum, and of but little more consistency. 



OF CHOLERA INFANTUM. 367 

to be admitted that our earliest endeavours are to be directed to 
the evacuation of the stomach and bowels. As regards, how- 
ever, the precise course to be pursued to effect this purpose, 
there is not the same unanimity of opinion. Generally, 
purgatives are employed in preference to emetics ; and espe- 
cially the castor oil. Cases of a mild nature may, undoubtedly, 
be treated in this way, and particularly if laudanum be occa- 
sionally added, when there is little or no fever. But, in the 
more violent forms of the disease, attended by vomiting, it will 
be impossible to get such medicines to be retained. It is, there- 
fore, necessary that we attempt to allay the irritability of the 
stomach. 

1419. For this purpose, there is nothing so certain, or so 
prompt, as an injection of a gill of warm water, in which is dis- 
solved a large teaspoonful of common salt : this is for a child 
of a year old and upward, proportionably less for younger. And, 
however frequent the discharges may be per anum, it must not 
be regarded; the injection must be given. If it operate imme- 
diately, and bring with it a faecal or bilious discharge, the sto- 
mach becomes almost immediately quieted, and it may then be re- 
peated only pro re nata — that is, whenever the vomiting may be 
severe. Should it not bring any thing off, it must be repeated ; 
and an attempt made to force it high into the bowels ; or, should 
the vomiting not cease, we must again have recourse to it. 

1420. This repetition of the injection will either procure the 
discharge required, or it will produce a most salutary irritation 
of the rectum, on which its chief efficacy depends. We would 
wish this fact to be remembered; for a common injection of mo- 
lasses, oil, and water, will do little or no good, though it may 
procure a stool, as it lacks the stimulating ingredient, the 
salt on which its virtue depends. So decided and effective is 
this simple plan, that we have a hundred times seen it relieve 
entirely, almost without the aid of any other remedy. 

1421. The great desideratum in cholera infantum is to tran- 
quillize the stomach: if the disease have been provoked by any 
irritating matter in the stomach itself, it should be our first en- 
deavour to remove it, by encouraging the puking, by draughts 
of warm, or even cold water, where the warm will not be drunk, 
until no foreign substance appears in the matter thrown up — 
but do not let us administer an emetic ; for, so long as na- 
ture continues her efforts to dislodge the offensive substance, it 
cannot be required, as she will certainly succeed, if she be aided 
by warm water; and it can neter be otherwise than injurious 
after it has cast off the irritating material. 

1422. When this complaint attacks very young children, 
nearly the same plan should be pursued — that is, an injection 
of the same materials must be given, of nearly the same 



6W OF CHOLERA INFANTUM. 

strength, but of less bulk, and this repeated when necessary — 
or, should the first not succeed in allaying the irritation of the 
stomach, it should be repeated in half an hour. A tea-spoonful 
of strong coffee, without sugar or milk, every fifteen minutes, 
should be given, especially to very young children ; but we be- 
lieve all ages would profit by it in larger doses. We have, in a 
number of instances, since we first tried it, seen it act like a 
charm. 

1423. In the commencement of this disease we have never 
seen the temporizing remedies, as the alkalies, the absorbents, 
or external irritants, of the smallest service ; we, therefore, 
never employ them. At this time, also, we discard all strong 
smelling substances from the room; and especially from the 
stomach within, or the belly without ; as mint, spices, brandy, 
gin, &c. ; as we are convinced they are extremely offensive to 
the stomach through the medium of the olfactory nerves. 

1424. If the stomach have not been tranquillized by the in- 
jection, or the strong coffee, we immediately commence with 
minute doses of calomel. We first prescribed the remedy in 
doses of half, a quarter, or an eighth of a grain, in cholera, in the 
year 1795; and we were, by some of our medical friends, se- 
verely ridiculed for the supposed insufficiency of the dose. 
But this did not deter us from the practice; for we have pur- 
sued it from that period until the present moment, though we 
could then gain but few to be of our opinion: since, however, 
Mr. Ayre has written on the subject, h has got into general use. 
We never combine opium with the calomel, in the early stage of 
the disease, being convinced it is better to exhibit it alone. — 
The following is the form and average dose we use : — 

R. Calora. ppt. gr. iij. 

Sacch. Alb. gr. vj. 

M. div. in par. xij. 

1425. One of these powders is thrown dry into the child's 
mouth every hour, until the bowels are decidedly operated on 
by them : this may be known by the stools being more copious, 
less frequent, and of a dark green colour, with a tenacious slime of 
the same or nearly the same tone of colour. When this change 
is observed, the powders are given much less frequently, say 
once in two, three, or four hours, as the symptoms may have 
abated or proved refractory. After the bowels have been well 
evacuated, and the child in pain, or pretty much exhausted, we 
order an injection in the evening, with laudanum, proportioned 
to the age of the child, provided there is not too much fever. 

1426. Should the symptoms persevere, we renew the treat- 
ment of the previous day, until similar effects be produced : and 
the laudanum injection at night: pretty much after this plan do 
we treat the first or acute form of the disease. If much fever 



OF CHOLERA INFANTUM. 369 

attend, with great gastric distress, we have found the most de- 
cided advantage from bleeding, or the application of leeches over 
the region of the stomach; or, if there be much cerebral de- 
termination, we bleed from the arm, or draw blood from the 
temples by leeches. We never, however, use leeches in the de- 
cline of the disease ; much caution is required in their use, lest 
we employ them at an improper period of the disease, or use 
them too freely. I believe that four or five leeches about the 
scrobiculis cordis is every way sufficient for that time, and should 
not be used more freely; we must always make allowance for 
the after bleeding, which is very abundant, nay, sometimes pro- 
fuse, and will require our immediate interference to arrest it. 
(See note, p. 358.) 

1427. Should irritation of stomach continue, and the legs and 
feet become cold, much good is frequently derived by blistering 
the legs, or from having them rubbed with mustard and warm 
vinegar, Cayenne pepper and warm brandy, until the action of 
the skin be excited. But from what has been said it will appear 
that our chief reliance is upon the use of the calomel. We are 
aware that many respectable practitioners are in the habit of 
giving larger doses of this article than we are : be it so — we are 
not at present, however, disposed to change a plan that has for 
so many years borne us out successfully in this truly fatal dis- 
ease. Let every practitioner proportion his doses agreeably to 
his own experience ; the administration of this remedy is all we 
are solicitous about. If one practitioner has found this remedy 
to succeed best in larger doses, let him employ them ; we are 
satisfied with its efficacy in more minute quantities. We all have 
the same object in view, namely, to quiet the irritation of sto- 
mach and bowels, and to make a decided impression on the he- 
patic circulation, to invigorate or calm its actions, and thus re- 
store the lost equilibrium in the distribution of the blood, which 
is essential to the performance of its natural functions. 

1428. Having thoroughly evacuated the primse vise, and re- 
established healthy secretions, we are to desist from purges ; we 
should be content with keeping the bowels in a soluble state 
only; unless we have evidence of re-accumulations of bilious 
and fouler contents, or of hepatic torpor and congestion, when 
the same course is to be renewed. But if irritation be exces- 
sive, and, as usual, productive of frequent and painful discharges, 
we may, with much advantage, administer anodyne injections 
three or four times in the course of twenty-four hours, after 
having applied a few leeches to the region of the stomach. These 
remedies will, in most cases, certainly calm the intestinal canal; 
and as soon as this happens, the acrid discharges, together with 
the other symptoms, very generally cease to be troublesome. 
Yet it will be occasionally necessary to administer a mild pur- 

24 _ 



370 OF CHOLERA INFANTUM. 

gative, to remove oppressive accumulations, when they manifest- 
ly exist: for this purpose, castor oil is best. 

1429. In addition to what has already been advised, for the 
management of this disease, we should be attentive to the means 
calculated to make a direct impression on the skin. For this 
purpose, the occasional use of the warm bath is highly impor- 
tant. Every case of cholera, as formerly stated, is more or less 
marked by great inequality of temperature — so much so, that 
one portion of the body will be parching hot, while another is 
"very cold. By immersing such a patient in warm water, we 
equalize temperature, and diffuse a glow over the entire surface, 
while other benefits are, at the same time, attained. The effects 
of the bath, however, are not lasting; and hence it is required 
to be repeated daily, or even oftener. It may be rendered more 
effectual, where there is much cutaneous insensibility, by adding 
to it salt, mustard or brandy — and, upon coming out, to employ 
frictions, &c. 

1430. We have already glanced at the use of blisters. They 
are serviceable at any stage of the disease, if unequal tempera- 
ture prevail ; and may be applied over the stomach, abdomen, 
or to the extremities, according to the state of the case, and the 
more striking indications ; that is, if the extremities be as warm 
as the abdomen, we may apply a blister over the region of the 
stomach: but if the legs be cold, blisters had better be applied 
to the calves of the legs, first irritating the surface by rubbing 
them with a little spirits of turpentine. In addition to their 
ordinary effects, they very usually promote perspiration. It is 
a fact not sufficiently known, that without vesication, in certain 
conditions of the skin, diaphoresis will not take place. 

1431. This plan, . however, proving unsuccessful, it must be 
intermitted ; and, the bowels continuing highly irritated, with 
bloody evacuations, we may try the oleaginous mixture, consist- 
ing of castor oil, gum Arabic, and laudanum — or what, perhaps, 
is still better, melted butter, or a union of sugar of lead, ipeca- 
cuanha, and opium. The lead here is occasionally very effica- 
cious. 

1432. In the course of a few days, in some instances, and in 
others, a week or more, the disease passes into the nature of 
diarrhoea, which, however, is sometimes attended by a slight de- 
gree of tormina and tenesmus. It is also usual, at this time, to 
find the stomach greatly debilitated, with the loss of the power 
of digestion ; and so irritable as hardly to retain any descrip- 
tion of nourishment. At this time, also, the stools are apt to 
become very watery and green; manifesting the predominance 
of acid. The remedies proper under such circumstances consist 
chiefly of the cretaceous and alkaline preparations, variously 
combined. 



OF CHOLERA INFANTUM. 371 

1433. They may be prescribed as follows: — 

R. Cret. Prep, vel Test. Ostreor. S' [SS ' 

Gum Arab. "> .. • 

Sacch. Alb. 5 aa 3J " 

Tinct. Theb. gtt. x. 

Aq. font. giij. :-J. 

R. Sal. Tart, vel Carb. Sod. gr. xxx. 

Gum Arab. ) •--_,- 
Sacch. Alb. J aa 6j * 

Tinct. Theb. gtt. x. 

Aq. font. §iij. M. 

A drop of the oil of cinnamon may be advantageously added 
sometimes to either form of the mixtures. Lime-water and 
milk may be also usefully employed. 

1434. At this period of the disease preparations of rhubarb 
are sometimes resorted to with advantage. The spiced or sim- 
ple syrup of rhubarb may be given, combined with small doses 
of laudanum. In the use of these preparations the dose is to 
be small, and repeated at stated intervals, so as to attain rather 
the tonic or astringent, than the purgative effect, of this medi- 
cine. 

1435. As the disease advances it loses most or all of its 
acute or painful symptoms, and becomes a colliquative diarrhoea ; 
and so profuse as to produce from ten to twenty stools in the 
twenty-four hours. 

1436. The treatment of this case is similar to that of chronic 
diarrhoea ; we shall only here point out some of the remedies 
suited to the cases of children. (See Chapter on Diarrhoea.) 

1437. Combinations of chalk, with the tincture of kino, or 
with an infusion of galls and laudanum, are worthy of confi- 
dence. The columbo in infusion has much reputation. An in- 
fusion of logwood has also been employed. The decoction of 
the pomegranate bark, or flowers, is said to be of great service. 
The dose of each of these preparations is nearly the same — 
about a dessert-spoonful to children above a year old, and less 
for younger. A strong infusion of the dew, or blackberry root 
is said by many to be useful ; it has never done much in our 
hands. By some practitioners the chalybeates are not a little 
prescribed — the best of which, agreeably to Dr. Chapman, is 
the supersaturated sulphate of iron, in the following formula ; — 

R. Sal. Martis. gr. ij. 

Acid. Sulph. dilut. gtt. x. 

Sacch. Alb. gj. 

Aq. Font. |j. M. The dose gj. 

1438. Even here, however, calomel is serviceable when there 
are marks of hepatic congestion, or want of bilious discharges, 
or the presence of vitiated humours. But the chalybeate must 
be laid aside, if it be proper to use the calomel, and the bitter 
infusion be given instead. 



372 OF CHOLERA INFANTUM.- 

1439. Exactly under similar circumstances, and especially If 
the mucous tissue of the bowels be much disordered, as is mani- 
fested by the loaded tongue and slimy stools, the spirit of tur- 
pentine has been found highly beneficial. With this we have 
several times succeeded, where all hope had been abandoned. — 
The dose is from five to ten drops, three or four times a day, in 
sweetened cold water. Before we dismiss this part of our subject, 
it may be well to observe that the occasional use of laudanum, 
when there is pain, is absolutely necessary: a flannel roller 
around the abdomen is sometimes productive of signal benefit. 

1440. This brings us to the consideration of regimen. In 
the commencement of the disease the diet &hould consist exclu- 
sively of breast milk ; which is of such importance that a nurse 
ought to be procured where the child has been weaned. It will, 
of itself, sometimes cure the disease. Caution, however, is ne- 
cessary, even here, as the child, from excessive thirsty may de- 
mand the breast too frequently, and thus overload its stomach ; 
the child therefore must not be permitted to suck too much or 
too often. If thirst be importunate, cold gum Arabic water 
may be given in small quantities frequently, instead of the often 
nursing. 1 But if the child will not take the breast, let it be fed 
on diluted sweetened milk, or barley or rice water and milk, or 
gum Arabic tea. These will serve also for drink. But balm, or 
marsh mallows tea, soda water, and burnt bread and water, may 
also be directed for this purpose. In the advanced stages the 
farinaceous articles may be employed — as very thin arrow root y 
tapioca, sago, rice, or boiled flour. Extreme debility of the 
stomach and bowels existing, and no fever present, a little ham 
or salt fish may be allowed. Yet the only remedy which is so- 
vereign, and nearly unfailing, is a change of air. As long as the 
child remains in the city, and exposed to the causes of the dis- 
ease, we may palliate or suspend its career, but can hardly ever 
make a radical cure — relapse upon relapse takes place, till the 
strength is finally exhausted. 

1441. Great benefit is gained by a removal to the country, in 
every stage of the complaint. It is even said by the late Dr. 
Bush, that he lost but three patients, where this advantage was 
commanded; and it must be admitted that there is nothing so 
effectual. As soon, almost, as the child gets into the country 
air, we may discover a change. Where we cannot have country 
residence entirely, it will be useful to ride out daily, or twice 
a- day. Crossing the river we have very often found highly bene- 
ficial. 

1442. To prevent a disease so difficult of management, and 

1 For the purpose here signified, an ounce of gum Arabic will be sufficient for 
a pint of water, nay, a quart sometimes, when the assimilating powers are feeble* 



OF WHOOPING COUGH. 375 

so destructive of life and happiness, we shall indicate those 
measures which common experience has found best. 

1443. 1. Never permit a child to be weaned within the year, 
when practicable to prevent it. No food is so salutary as the 
natural milk. As respects this complaint, weaning always pre- 
disposes to its attacks. 

1444. 2. Direct the wearing of flannel next to the skin, and 
worsted stockings. The great benefit of this system is experi- 
enced by grown persons, prone to intestinal complaints, and we 
know its utility to be no less in children. 

1445. 3. Duly regulate the diet— let an excess of any fruit 
be avoided, and absolutely abstain from unripe or unwholesome 
kinds. The proper food of a child is, substantially, milk, with 
farinaceous matters, such as arrow-root, rice, biscuit, &c. After 
a few months, provided it has teeth, it will be useful to accus- 
tom it to a little animal food. It strengthens the powers of 
digestion and the general tone of the alimentary canal. 

1446. 4. During dentition, let the gums be frequently ex- 
amined, and if any appearance of swelling or inflammation exist 
in them, they must be lanced. Dentition, during hot weather, 
is but too apt to excite cholera ; and, if the complaint exist, it 
never fails to aggravate it. (See Chapter on Dentition.) 

1447. 5. Let the child, when practicable, be removed to the 
country: but not too early in the season. 



CHAPTER XXIX. 



1448. Whoopixg-cough usually begins like a cold, with more 
or less fever, and catarrhal defluxions — these continue, in some 
instances, throughout every stage of the complaint; while in 
others they cease in a few days. The onset of the disease is, 
for the most part, abrupt, without any distinct febrile movement, 
and is sometimes early attended by the peculiar inspiration which 
gives it its common name. At other times a considerable period 
elapses before this takes place ; and, in some cases, it does not 
happen. Cullen tells us he has had instances of a disease 
" which, though evidently arising from the chin-cough contagion, 
never put on any other form than that of common catarrh." 

1449. The disease becoming confirmed, the paroxysm consists 
of a number of short expirations, closely following each other, 
so as to produce a sense of suffocation: to overcome this, a violent 



Orf4 OF WHOOPING COUGH. 

effort of coughing is made, "which usually ends in vomiting, or a 
discharge of phlegm or mucus from the lungs. In many cases, 
when the paroxysm is over, there is complete relief in the inter- 
val ; so much so, that the individual seems not at all affected, 
except, perhaps, temporarily, a little weakened. 

1450. This complaint is not accompanied by a difficulty of 
breathing as a necessary attendant, unless in such as may have 
a chronic affection of the thoracic viscera. If it attend whoop- 
ing-cough in such as have no pectoral complaint ordinarily, it 
betrays, for the most part, some latent mischief in either the 
bronchial membrane or the substance of the lungs themselves 
— this may be either inflammation or engorgement. 

1451. Dr. Watt says that whooping-cough is sometimes at- 
tended with great torpor of the bowels, requiring large and 
frequent doses of medicine before it can be overcome. We have 
never witnessed this condition; and when it does occur, it is, 
perhaps, only relative; the coats of the stomach and bowels 
being "varnished," as it were, with mucus ; and thus preventing 
the operation of medicine, by not permitting contact between 
the medicine and the intestinal membrane. Also that the uri- 
nary secretion is influenced, and micturition produced. 

1452. In the commencement expectoration is sometimes very 
deficient ; the cough is hard and dry ; the paroxysms recur fre- 
quently, and are long continued. Congestion of the lungs now 
takes place; which produces, by the interruption of the circula- 
tion in these organs, a correspondent state of the head ; and, as 
a consequence, a turgescence and suffusion of face, amounting 
sometimes even to lividity, which is occasionally relieved by 
gushes of blood from the mouth, nose, eyes, or ears. In this 
manner the disease runs an indefinite course, from one month 
to three, or even twelve months; though the average is, perhaps, 
the second period. This, however, very much depends on the 
season of the year; it being always of longer duration in winter. 
The popular notion is, and which is not far from the fact, that 
it is six weeks in reaching its height, continues for some time 
with but little abatement, then declines, and goes off in six weeks 
more. 

1453. Some writers, especially Webster, consider the whoop- 
ing-cough as consisting in some cerebral disorder; and adduce, 
as evidence, the existence of headache, redness of the eyes and 
cheeks, and the relief that a bleeding at the nose affords, to- 
gether with the appearance of the brain and its appendages after 
death. Dr. Gregory, like Webster, speaks "of a tensive pain 
of the forehead; and, in severe cases, this is obviously an urgent 
symptom, and one which demands attention in reference to 
practice." We have paid considerable attention, ever since we 
read Mr. Webster's paper on whooping-cough, to the symptoms 



OF WHOOPING COUGH. 375 

which particularly mark this disease, but we have never satisfied 
ourselves of the existence of any 'primary cerebral disorder. We 
have occasionally had confessions from our patients, that they 
had more or less headache, especially after violent coughing ; 
but there is surely nothing in this more than might be expected 
from such efforts of the chest as this disease demands. And of 
the "tensive" pain in the forehead just spoken of, we have never 
been certain that it existed even late in the disease. This may 
have arisen from our patients, at least nineteen out of twenty 
whom we have examined with this view, being too young to 
either describe it, or to make them sensible of our meaning: 
with the few whom we interrogated that could comprehend what 
we suppose Mr. Webster intended by the expression, it was cer- 
tainly wanting. Nor is the relief experienced by a bleeding 
from the nose any proof of the existence of the disordered condi- 
tion of the brain and its appendages ; since this kind of bleeding 
very certainly removes pain from the head, when the mucous 
membrane of the frontal sinuses are inflamed in catarrh. Be- 
sides, the existence of the appearances after death, noticed by 
Mr. Webster, does not appear to be confirmed by Laennec. 
And Dr. Watt says that this disease is proved by dissection to 
be bronchitis. Guibert considers whooping-cough as ''essen- 
tially nervous or spasmodic:" he says, "With several authors, 
I look upon the convulsive cough as a nervous disease, produced 
by a spasmodic affection of the glottis and diaphragm. But 
this spasm is seldom uncombined or idiopathic ; and in the ma- 
jority of cases it is coincident with some other affection of the 
organs of respiration, as bronchitis, pneumonia, pleurisy, and 
sometimes phthisis. In a word the whooping-cough is a disease 
essentially nervous or spasmodic, and which may exist alone, 
and without any evident cause, but is generally attended by a 
disease which has, for the most part, its seat in the respiratory 
organs, and which necessarily modifies the progress, duration 
and mode of treatment of the whooping cough so decidedly, as 
to induce the belief that it is the only exciting cause. From 
this it would follow that all the idiopathic diseases which may 
have cough as a prominent symptom, may also be attended by 
whooping, which will then appear to be nothing more than a 
peculiar modification of the ordinary cough. My opinion is 
founded, first, upon the diversity and contradictory theories of 
authors upon this subject, and which start with the assumption, 
that the disease is situated in this or that organ; 2dly, in this 
disease being complicated, for the most part, with some other 
disease ; 3dly, from the uncertainty of any mode of treatment, 
and the similarity of result from opposite modes of treatment ; 
and, 4thly, upon clinical observation, and the inspection of the 
bodies of those who have died of the disease," (pp. 145, 146.) 



376 OF WHOOPING COUGH. 

In this account of M. Guibert, we see nothing but an attempt 
at new views, without the slightest practical advantage; and the 
whole of his hypothesis upon this disease is, in our opinion, con- 
tradicted by the fact, that, as a general rule, it never occurs 
more than once in the same individual, which would not be the 
case were his opinion justly founded. 

The same may be said of Dr. Alclerson's pathology of this 
disease. He makes it consist in an inflammation in the air cells 
of the lungs; in which, he says, "mucus is secreted in less 
quantity than usual, a fibrinous exudation takes place, and ad- 
hesion of the parietes of the cells is the consequence; whilst the 
cellular membrane separating the individual lobules retains its 
natural structure." (Medico-Chirur. Trans., published by the 
Medical Chirurgical Society of London, vol. XVI. part I.) 

Now, the inflammation spoken of, no doubt, in most instances, 
really exists — but bronchitis, for it is nothing more nor less, 
simply considered, is not sufficient to account for the -whole of 
the phenomena of the whooping cough, as we have this moment 
intimated of M. Guibert's views. 

1454. With respect to the origin of pertussis, there is consi- 
derable doubt. It is supposed to depend on a specific contagion, 
which affects persons only once. To this, however, there may 
be exceptions. While it is pretty generally admitted that the 
disease proceeds from contagion, there are writers who maintain 
that it occasionally, at least, prevails as an epidemic ; and, hence, 
must originate in a more common source. Much discussion has 
lately taken place on this point; but the facts are not sufficiently 
numerous, nor well authenticated, to warrant any very positive 
conclusion. 

1455. Yet we confess that we are inclined to believe that it 
depends on causes of a more general and pervading influence 
than contagion. 

1456. That it does, in some instances, arise from other causes 
than contagion, seems quite certain. Willis, who was the first 
to describe it accurately, declares it to be an epidemic, occurring 
most commonly in spring and autumn. By Hoffmann, it is said 
to have spread in Berlin to a great extent, in the same way. 
In the tenth volume of the Medical Repository of New York, Dr. 
Willey gives an account of the disease having suddenly broken 
out in Block Island, and where it prevailed widely, without the 
inhabitants of the place having had any intercourse with an 
infected source. It is a rule, with few or no exceptions, that, 
where a disease can be traced to atmospherical influence, it does 
not prove contagious. Nature, indeed, can hardly employ two 
such opposite causes to produce the same effect. 1 

1 It is a well known fact, that many become affected, where every precaution 



OF WHOOPING COUGH. 377 

1457. Believing that the complaint is generated by specific 
contagion, we have, perhaps, too much neglected to look for 
other causes of its production. Yet, on the whole, in the present 
state of our knowledge, it will be most prudent to proceed in 
practice, under the impression of its contagious nature. 

1458. It may be inferred, from the history of the disease, 
that the diagnosis is neither difficult nor obscure. But this is 
not exactly so ; for in its commencement it so much resembles 
the common catarrh, that it is almost always mistaken for it, 
especially in early spring and late autumn ; nor can it well be 
decided which disease it may be, until the permanency and ob- 
stinacy of the affection declare it to be whooping cough. 

1459. The remote cause of whooping cough may be received 
at the moment catarrh is about to make its appearance; and 
thus may be confounded with it ; or it may be called into action 
by the catarrhal affection, and thus perpetuate the symptoms 
of this disease. Or it may, and we believe it often does, at the 
periods just named, assume all the forms of catarrh, and from 
which, in the commencement, it would be impossible to decide 
whether the affection under consideration be whooping cough or 
catarrh; for whooping cough, at its onset in the spring and fall, 
is attended by as much febrile action as catarrh; and it is not 
until this inflammatory stage is about to pass away, that the 
cough assumes the paroxysmal form, and declares the disease 
to be whooping cough. When the spring is pretty far advanced, 
and during the hot weather of summer, whooping cough is rarely 
confounded with catarrh: for at these periods there will be less 
fever, and the disease will more quickly betray its peculiar cha- 
racter. But, fortunately, no evil can arise from their being 
confounded ; for at this period their treatment must be precisely 
the same. It also resembles the initiatory symptoms of measles ; 
for in whooping cough there is sneezing, watery eyes, swelling 
of the eyelids, and an unusual fulness of the face. But the 
doubts to which of the diseases these symptoms belong is, for 

is taken to avoid contagion; and that the disease is uniformly relieved, or even 
cured by a removal beyond the limits of the supposed distempered atmosphere. 

Agreeably to Desruelles, the following writers have described epidemic whoop- 
ing-cough: — 

Traite de la Coqueluche, p. 100, &c. &c. 

Pasquier speaks of an epidemic of this kind, that broke out in March, 1411. 
More than one hundred thousand in Paris alone, were attacked with it. This 
account is confirmed by Mezeray. 

De Thou relates another epidemic that besieged Paris in 1510: this was called 
whooping-cough; the symptoms were not related by him, though mentioned by 
Sennertus. 

Riverius mentions one that spread over almost the whole of Europe in 1557. 

Baillou gives an account of one in 1578. 

Geller describes one that took place in 1757, in the duchy of Mechlenburg. 

Aaskow, one that happened at Copenhagen, 1775. 

Arand, one that occurred at Mayence, in 1769, &c. &c. 

It thus appears that this disease has occasionally appeared in an epidemic form 
from 1411 to 1815. The last, that is, of 1815, is said to have occurred at Milan. 



378 OF WHOOP IX G COUGH. 

the most part, soon cleared up, by the eruption taking place in 
measles on the third or fourth day after the commencement of 
the catarrhal affection. It is, however, said, that instances of 
measles have occurred without any eruption having taken place, 
but this we have never seen. 

1460. This disease is generally most severe with infants, as 
they cannot expectorate with the same freedom as older children, 
and are thus debarred this source of relief. Where it attacks 
with much fever and catarrh, it is also unfavourable ; and with 
pneumonia, or peripneumonia notha, still more so. Consump- 
tive subjects rarely or never recover. The favourable circum- 
stances are — absence of fever, and oppression ; free expecto- 
ration, and facility of vomiting. The disease terminates, some- 
times, by the gradual wasting of strength, or runs into chronic 
affections, as consumption, asthma, hydrothorax and hydrocepha- 
lus, or, suddenly, by apoplexy, or suffocation, from spasm of the 
glottis. 

1461. It is obvious that the irritation of the remote cause, 
wherever it may be primarily seated, induces an inflammation of 
the mucous membranes of different parts of the organs of respi- 
ration, occasioning an increased secretion of fluid; which, accu- 
mulating, acts as an extraneous substance, and brings on the 
cough for its expulsion. When this natural effort succeeds, there 
is for a time a complete interruption of the coughing; but on its 
being reproduced, we have a repetition of the paroxysm. By 
too long a continuance of this irritation, disorganization takes 
place in the lungs, &c. ; and the system at large participating 
in the morbid affection, a gradual exhaustion of strength, and 
death takes place ; or the air-cells being choked up, or the glot- 
tis closed by spasm, or by collections of mucus, or lymph, the 
patient dies suddenly from. suffocation: or, possibly, in some in- 
stances, as is represented, the brain may become so affected as 
to constitute a new and more complicated case, terminating life 
by coma, convulsions, &c. At this period an inflammatory state 
of the system undoubtedly exists ; it, however, exhibits a very 
peculiar character, owing, perhaps, to the nature of the cause 
by which it is excited; for it, unquestionably, is far less obedient 
to the usual remedies than ordinary inflammation ; and, in many 
respects, proves illustrative of the modification which this con- 
dition receives from the agent producing it. 

1462. Dr. Watt regards this disease as essentially an inflam- 
mation of the mucous membrane of the bronchia; and that when 
it terminates fatally, it is generally by the production of severe 
bronchitis. Laennec says that whooping cough holds a middle 
place between the mucous catarrh and pituitous catarrh, as far 
as regards the nature of the expectoration and the bronchial 
congestion; but that it possesses some characters peculiar to 



OF WHOOPING COUGH. 379 

itself. Such rarely occurs twice in the same person ; the cough 
taking place by fits : "Each fit," he says, "is composed of a 
quick succession of sonorous coughs, with scarcely any percep- 
tible inspiration between ; except that, from time to time, the 
expirations of coughing are suddenly interrupted by a very deep, 
seemingly convulsive, and noisy inspiration, accompanied by a 
lengthened hissing, which constitutes the pathognomonic sign 
of this variety of catarrh." "The stethoscopic exploration of 
the chest in the intervals of the fits, supplies only the usual re- 
sults of catarrh — namely, a feebler respiration than natural, or 
the complete absence of this in certain points, which, however, 
sound well — puerile respiration in other parts, and, occasionally, 
a slight sonorous or sibilous mucous rattle." 

1463. Desruelles makes it consist of an inflammation of the 
bronchia, complicated with cephalic irritation. But that the 
" inflammation des bronches est toujours primitive, et l'irritation 
du cerveau consecutive," p. 77. We can readily imagine that the 
brain, or its appendages, may indirectly become implicated with 
whooping cough, since the very efforts of the thorax, during the 
paroxysms, are well calculated to force an unusual quantity of 
blood into the brain — we, therefore, need not be surprised, that 
dissections have revealed water in its ventricles, though we can- 
not admit that the inflammation which terminated by the effusion 
of water, was the cause of the affection of the lungs. 1 Desruelles 
considers whooping cough as essentially inflammatory, under 
all its modifications and appearances. He says, "A quelques 
causes que puissent etre attributes les modifications que presente 
la coqueluche; quelles que soient l'activite ou la lenteur de sa 

'Dr. Palmer (Illustrations of Medicine, p. 183) has adopted the following pa- 
thology. He says, " During the violent paroxysms of the cough, the blood is pro- 
pelled in undue quantity and with increased impetus to the brain; and the irrita- 
ted and loaded organ reacts with augmented violence on the local malady. Nu- 
merous facts are illustrated by this view in the history of chin cough. Of these, 
the most striking are — the absence of the convulsive character in the other in- 
flammations of the air passages not complicated with cerebral irritation;— the ex- 
istence of the cerebral symptoms invariably observed even in the mildest form of 
chin cough; — the frequency of nasal hemorrhage, and the marked relief of the 
bronchial affection resulting from it; — the notorious tendency of the brain to 
active disease in whooping-cough; from which some writers have been erroneously 
led to infer that the latter is simyly a cerebral affection; — and lastly, the mainte- 
nance of the convulsive character long after every trace of the original inflamma- 
tion of the respiratory membrane has disappeared; 1 and the final removal of the 
disease, at that period by spinal irritants, powerful moral impressions, or other 
agents which can exert no direct influence upon the bronchial membrane, or any 
other organs, except the spinal marrow and the brain." 

' This clearly explains one of the sources from which error has arisen in investigations of the 
morbid anatomy of chin cough. A child is destroyed by an affection of the brain, eoiwected 
widi the disease in its later stages ; and, consequently, after every visible trace of the bronchial 
inflammation has disappeared. On dissection, the bronchial membrane is found in a natural 
condition : and hence, an api arently correct, although erroneous inference may be drawn, that a 
morbid state of this membram: constitutes no essential character of whooping cough. 



380 OF WHOOPING COUGH. 

marclie la violence ou la faiblesse de ses symptomes, la prompti- 
tude ou le retard de sa guerison, son etat de siniplicite ou do 
complication, son issue heureuse ou funeste, cette affection offre 
toujours les caracteres d'une maladie inflammatoire dout les dif- 
ferens degres sont les principales causes des formes diverses 
qu'elle revet," p. 217. 

1464. Notwithstanding a more correct light has been shed on 
the pathology of whooping cough, little new is proposed in the 
management of it. 

1465. As the whole of the phenomena at the commencement 
of this disease declare it to be catarrhal; and as, in most in- 
stances, in the cold part of our seasons, it is attended with fever, 
and marks of local irritation and inflammation, there is the most 
decided necessity for treating this complaint byevacuants; as 
blood-letting, laxatives, and emetics, and these to be repeated 
according to the exigency of the case. These should be perse- 
vered in until they produce direct evidence that the inflammatory 
stage of the disease is abated or subdued ; or, in a word, let the 
disease, in the first instance, be considered as nothing more than 
a violent catarrh, and be treated accordingly. 

1466. We are persuaded that this disease oftentimes becomes 
inveterate, and sometimes dangerous, from prescriptions being 
based upon a mistaken pathology. Thus, both Burton 1 and 
Millar 2 rejected blood-letting altogether, though Millar some- 
times ventured upon the application of leeches. Lieutaud 3 never 
employed it but in extreme cases ; that is, when the fever was 
very violent and the respiration difficult, &c. We would, there- 
fore, wish the reader to keep in mind the opinions of Laennec, 
Desruelles, Watt, and others, that in whooping, the bronchia or 
other portions of the lungs are sure to be in a state of inflamma- 
tion, especially in its commencement ; and if proper depletion 
be neglected, a second stage is formed of the disease, and we 
then find a disposition, to either metastasis to the brain, or find 
that it participates severely with the original complaint — hence, 
convulsions, inflammation of the brain, or hydrocephalus, are 
found to supervene. 

1467. Bleeding is demanded, in many instances, indepen- 
dently of other circumstances, by the interrupted circulation of 
the lungs ; and affords, almost always, the most decided relief. 4 
And this must be repeated as the necessity for it may continue, 
or as this necessity may subsequently return in the progress of 
the case. Even in Europe, where the lancet, comparatively, is 
so sparingly employed, this practice is commended, and gene- 

1 Appendix to Treatise on the Non Naturales. 

2 Observations on the Asthma and Whooping cough. 3 Med. Prat. 

* By bleeding, we wish to be understood, taking blood from the general system, 
by means of the lancet. 



OF WHOOPING COUGH. 381 

rally pursued ; but in this country its employment for the most 
part is indispensable. 

14G8. This was the practice of Willis, who was the first to 
give a regular account of this disease; 1 he chiefly relied, for its 
cure, upon vomiting, purging, and blistering. This appears, too, 
to have been the general practice of the age, and particularly of 
Sydenham ; and we have, among many inferior names, those of 
Astruc, Huxham, Hoffman, Hillary, Home, Lettsom, &c, in fa- 
vour of this course of treatment. 

1469. Evacuations of the alimentary canal must also be brought 
in aid of bleeding; and these may be made by emetics or laxa- 
tives ; of the latter, the best is castor oil, after the bowels have 
once been opened by calomel. The former are chiefly applicable 
to children ; and, where the attack is violent and the oppression 
great, they maybe repeated, provided the accumulation of phlegm 
is great and threatening. To keep up the impression on the 
stomach, small doses of the syrup of squills, or ipecacuanha, 
should be given in the intervals. Or, what has answered all 
these intentions with the most decided efficacy, is Coxe's hive 
syrup, given in proper closes. 

1470. We always have recourse to this medicine immediately 
after bleeding, (if this have been necessary) and after having 
purged with calomel, hive syrup must be given in such doses as 
shall freely promote expectoration ; or should there be oppres- 
sion, or evidence of great accumulation of phlegm in the wind- 
pipe and lungs, in such quantity as shall freely puke. We, for 
the first purpose, order doses suitable to the age of the child, 
every hour or two, as it may show its' effects. For a child of 
three or four months old, we would order eight drops every hour 
or two, and a proportionally larger quantity as the age advances ; 
and, for the second view, we would give these quantities every 
fifteen minutes, until an emetic operation be produced. Let it 
be, however, remembered, that children of the same age will 
bear very different quantities of this medicine, as well as of every 
other; therefore, the doses must be constantly regulated by the 
effects. After this medicine has operated as an emetic, it must 
be given, as before directed, as an expectorant. 2 But should 

1 This was in 1664. 

2 The following is the recipe for making the compound syrup of squills, ot 
Coxe's hive syrup. Take of 

Seneca snake root, bruised ) -Lite j 

Squills, dried and bruised \ each flalf a P oun(L 
Water - - eight pounds. 

Boil together, over a slow fire, till the water is half consumed ; strain of? the 
liquor, and then add of strained honey four pints. 

Boil the honey and strained liquor to six pounds, or to the consistence of a syrup; 
and, to every pound of the syrup, add sixteen grains of tartar emetic; that is, one 
grain to every ounce, 



382 OF WHOOPING COUGH. 

bleeding not have been necessary, the case will rarely require 
more than demulcent drinks and a low diet. 

1471. The state of the expectoration is a matter of conse- 
quence, and should always be attended to; for from it much 
may be learnt. After the disease, in favourable cases, has ar- 
rived at its height, or is upon the decline, the expectoration be- 
comes more profuse, and the sputa lose their mucous character, 
by assuming a more purulent appearance. But if this take place 
suddenly, or in the early part of the disease, it is, for the most 
part, an unfavourable sign. Nor is blood mixed with the expec- 
torated matter, a good token, generally speaking. 

1472. The most abstemious diet should be observed during the 
whole of the catarrhal stage of this complaint, which is from 
three to six weeks, according to the season. Children at the 
breast should receive nothing but the mother's milk; those who 
are weaned should be confined strictly to a milk and vegetable 
diet. All animal food, or broths, must most scrupulously be 
avoided. Rennet whey is preferable to whole milk. The drinks 
should be barley water, flax-seed tea, gum Arabic water, bran 
tea, toast water, or molasses and water. 

1473. The milder laxatives, though recommended by many, 
do not answer as well as calomel for the first purging; for inde- 
pendently of its purgative effects, this medicine would seem to 
exercise some other power. Certain it is, that active evacua- 
tions by calomel, in the commencement of the disease have, in 
a greater or less degree, the effect of breaking down the force 
of the catarrhal symptoms, and to abridge the career of the dis- 
ease. We, therefore, almost always commence the treatment 
with a mercurial purge; and repeat this for the first two or 
three days, if the condition of the bowels require it. What- 
ever opinion may be adopted of its mode of action, we are cer- 
tain of its utility ; and as there can be no dispute as to the pro- 
priety of having the bowels well opened in the beginning of the 
disease, calomel seems to be the best suited to this purpose. 

1474. During the general treatment pointed out, we are not 
wholly to lose sight of some local remedies in this disease. Con- 
gestion and inflammation of the lungs are apt to take place ; for 
the relief of which, blisters are found decidedly advantageous 
after proper evacuations; or, should it be necessary to draw 
more blood, let it be done by leeches or cups, from between the 
shoulders. We are decidedly of opinion that blood caflnot be- 
taken by leeches or cups, with any thing like the same advan- 
tage from any other part, where there is a threatened congestion 
of the lungs ; and it sometimes becomes important to follow this 
up by a blister to the same part. 

1475. When there is a strong determination to the head, the 
same remedies are required, both general and local. Leeches 



or WHOOPING COUGH. 383 

to the temples we have found of singular advantage, where much 
pain in the head was experienced after each spell of coughing; 
indeed, we now never neglect this last symptom, as we are con- 
vinced it was the prelude to a fatal issue in two or three cases 
we have seen by extravasation within the brain — and who has not- 
witnessed the advantage* or at least the immediate relief, from 
an accidental bleeding at the nose? 

1476; Though we admit of determination of blood to the head 
in this disease, and recommend, as just stated, local depletion 
for its relief, we are by no means of opinion that either this de- 
termination, or an inflammation of the brain, or its appendages, 
has the least agency in the production, or even the perpetua- 
tion, of the cough with which either may be associated. Yet 
the supervention of inflammation, or even a congestive state of 
the brain, will very much increase the danger of the patient — 
therefore, these conditions require the active means just recom- 
mended for their relief. Nature sometimes furnishes the means 
of relief herself, by instituting a bleeding from the nose — this, 
when sufficiently extensive, affords more relief than either cup- 
ping or leeching, and should, therefore, always be encouraged 
to an extent every way compatible with the exigency of the 
symptoms, and the strength of the patient, if this be practi- 
cable. 

1477. But let it be remembered that the bleeding from the 
nose, however instrumental and speedy it may be in abating the 
violence of the marks of determination to the head, or of con- 
gestion in the brain, only proves the immediate condition of 
these parts, and not an original agency in the production of 
whooping-cough. 

1478. In the use of the remedies recommended above, we 
would wish it to be understood, that we do not always prescribe 
bleeding, or loss of blood, in any other way, in every case of 
whooping cough, as it very often presents itself without the 
symptoms which would justify this, or, perhaps, any other re- 
medy, except occasionally the use of the syrup, as just directed, 
to secure a free expectoration, or, the administration of a few 
grains of calomel; or, what is better, after the first few days of 
the disease, the occasional use of castor oil, if the bowels be 
confined. 

1479. If due regard have been paid to the treatment of the 
inflammatory or catarrhal stage of whooping cough; or if the 
remedies for subduing this state have been successful; a second 
period of this disease will arrive, in which other remedies may 
be useful. But it should be carefully ascertained before the 
character of the remedies is changed, that every vestige of in- 
flammatory action shall have ceased; therefore, the pulse must 
be carefully examined, and it must be found sufficiently sub- 



884 or whooping cough. 

dued, before we commence with the antispasmodic and tonic re- 
medies. 

1480. Desruelles finds much fault with these directions : he 
says, "Comment se fait-il que le Docteur Dewees, qui montre 
tant de confiance dans le regime, qui le present avec tant de 
reserve et de sagesse, ait cru necessaire de donner l'emetique, 
d'entretenir les nausees par des petites doses d'ipecacuanha, de 
purger souvent avec calomelas et de s'abandonner a Taction in- 
certaine et souvent nuisible des narcotiques, des antispasmo- 
diques, et meme des toniques ? II preconise la saignee et la diete, 
et ila dministre des medicamens stimulans: n'est-ce pas detruire 
cl'une main se que Ton a fait de l'autre ? Par quelle etrange 
association d'idees peut-on faire concourir au meme resultat des 
moyens si opposes, si contradictoires? " (p. 242.) 

1481. In answer to the above questions, it will be only neces- 
sary to say that we differ a little in the progressive pathology of 
whooping cough, and on this circumstance does the difference of 
our treatment arise. Desruelles considers the bronchia at least, 
if not the brain or its appendages, to be in a state of phlogosis 
during the whole continuance of the cough; while we are of 
opinion that the stage of inflammation passes away, and that if 
the cough continue after the pulse declares the absence of febrile 
action, that it arises from some impression upon the nervous 
system, or that it may then become the cough of habit. With 
this belief in view, we prescribe a rigid diet, order bleeding, 
either general or topical, or both, purging, &c. ; but, after the 
necessity for this discipline has ceased, we think we have always 
found it useful to give antispasmodics or tonics. 

1482. We do not order, as will be perceived, these different 
plans at one and the same time; for we have just insisted, 
that ''before the character of the remedies is changed, we should 
carefully ascertain that every vestige of inflammatory action has 
ceased." There is certainly no inconsistency in this practice 
— nay, it is very often essential to the cure of many affections, 
as fevers, and especially intermittents, that the system be re- 
duced before tonics are given. We have just stated that Desru- 
elles looks upon the whooping cough to be essentially an inflam- 
matory disease, under all its modifications, and through the whole 
of its career, and that it consequently requires an antiphlogistic 
treatment from its commencement to its final departure, but as 
we have never had any reason to be of this opinion ourselves, we 
have not adopted the notions of this author upon this point. The 
difference of our views of the character of the disease during its 
progress, will readily account for the difference of our plans of 
treatment. We might retort his queries with equal propriety to 
him, when he insists upon one uniform mode of practice through 
the whole course of the disease; for to us it appears as incon- 
sistent as our plan does to him. 



or WHOOPING COUGH. 385 

1483. In justice, however, to him, we admit that we. have 
seen a number of cases of whooping cough subdued, and that 
speedily, in some instances, by a perseverance in the antiphlo- 
gistic plan of treatment; but on the other hand, in justice to 
ourselves, we must say that we have seen very many more that 
required the treatment that we have laid down. 

1484. We believe it has been chiefly owing to want of atten- 
tion to the state of the pulse, that this disease has not yielded 
more generally to the influence of remedies — for it has been 
prescribed for more empirically than almost any other complaint 
in the long catalogue of human diseases. Should the first stage 
have been neglected, or improperly treated, the disease will pur- 
sue its course in spite of all opposition ; and the patient may be 
felicitated when it takes its departure, however protracted this 
may be, and leaves not behind more serious evils than were ex- 
perienced by its presence. 

1485. We have no confidence in the opinion that this disease 
will have a determined course ; and that we can only relieve the 
pressure or inconvenience of the immediate symptoms, though 
it is urged by Sydenham himself. Nor should we inculcate this 
belief, until it be a well ascertained fact, as it would but too 
certainly foster supineness and indifference in the treatment of 
this formidable disease. Too much has already been taken for 
granted upon this subject; and, because we are not yet in pos- 
session of proper counter agents to this complaint, it certainly 
does not prove it to be indomitable. The intermittent fever 
and lues venerea, were once thought to be equally, if not more 
unmanageable, than whooping-cough; but the discovery of the 
bark, and the use of mercury have rendered them comparatively 
harmless diseases : the proper or appropriate remedy for whoop- 
ing cough may, therefore, be yet discovered. 

1486. If the opinion prevail that whooping cough will have 
a definite duration, all exertion to abridge its career will be 
paralyzed, and the poor suffering infants and children will be 
deprived of even the moderate aid it is now in our power to give. 
As regards ourselves, we are decidedly of opinion that its dura- 
tion may be as certainly shortened as the march of fever ; nor 
do we say this upon slight or inadequate grounds, if our obser- 
vations have not deceived us. We have known this disease to 
be made run its course in eight members of the same family, 
and at the same time, in less than six weeks ; and in many other 
instances the period has been abridged with equal success.' But 
what has entirely confirmed us in the persuasion that the period 
of this disease can be shortened, nay, even stopped short in some 
instances, was the success we once witnessed from the exhibition 
of the tincture of artificial musk, in a family of five children, 
who were all labouring under confirmed whooping cough. 



386 OF WHOOPING COUGH. 

1487. When we prescribed this remedy, the disease had been 
of about two weeks' standing : all the children were attacked 
within the period of a week ; the catarrhal symptoms were very 
mild ; it was summer, and they readily yielded to a moderate 
antiphlogistic plan. All inflammatory action was completely 
subdued, and all the children were put upon the use of the ar- 
tificial musk at the same time. One, the youngest, (eleven 
months old,) ceased to cough altogether in less than a week, and 
neither of the others continued as long as a fortnight. 

1488. We, however, confess we have not seen so striking an 
instance of the influence of this article since ; though we are 
every way convinced it is a valuable remedy in this disease, and 
one that we have long been in the habit of using. 

1489. Another disadvantage arising from the belief that this 
disease cannot be shortened, is the neglect of early measures 
to subdue or moderate the inflammatory action of the system 
in its commencement : in consequence of this, cerebral and 
pulmonic congestions form, of which the patient, perhaps, speed- 
ily dies, or such disorganization takes place as to render him 
miserable for life. This doctrine is not understood by people 
in general — for when it is declared we cannot abridge the period 
of the disease, it is always understood to mean we can do no 
good in whooping cough; of course, the physician is but too 
rarely employed in this complaint. Yet we are certain there 
are few diseases in which more relief is experienced than well 
treated whooping cough in the commencement : of this opinion 
also was the experienced Dr. Underwood, who declares, " There 
is no complaint of children, with which I am acquainted, in 
which medicine is at times more evidently serviceable, than in 
bad whooping cough." Then why should poor children be aban- 
doned, in this formidable complaint, for an ill-sustained hypo- 
thesis, or popular belief? 

1490. Narcotics and antispasmodics are also directed at this 
period of the disease : among these, opium claims our first no- 
tice. After evacuations have been duly made, and there is a 
proper abatement of fever, or other marks of irritation, its use 
as a palliative of the more troublesome symptoms is sanctioned 
by the experience of almost every body. The pleasantest, and 
we believe the best form for its exhibition, is in the brown mix- 
ture, in suitable doses at night. 1 Dr. Edwin P. Atlee recom- 



1 The following is the 


formula for the brown mixture; so called from its co- 


lour : — 












»E*. Elix. Paregor. 


S' 






Take Paregoric Elixir 


1 ounce. 


Vin. Antimon. 


Sss. 






Antimonial Wine 


-£ ounce. 


Sue. Glycirrh. 


3»j- 






Liquorice Ball 


3 drams. 


Pulv. G. Arab. 


stf- 






Gum Arabic 


2 drams. 


Aq. Fervent. 


I v j- 


M. 


ft. 


sol. Hot water 


6 ounces. 
Mix. 



Of this, a child from four months to six, may take a small tea-spoonful every two 



OF WHOOPING COUGH. 387 

mends, with much confidence, the Prussic acid. The following is 
his formula: — 

R Acid Hydrocyanic, gut. iv. 
Syr. Simp. ^ij. M. 

A tea-spoonful, morning and evening, for the first day — three 
times a day after. — American Journ. of Med. Sciences, for May, 
1832. 

And Dr. Bland gives the sulphuret of potash in this disease. 
He advises it in doses of ten grains, morning and evening, in a 
little honey. — lb. 

1491. During the prevalence of the pathology which ascribed 
the disease to spasm, antispasmodics were the chief remedies. — 
Of this class the whole were tried in succession, and particular- 
ly the castor, artificial musk, and asafoetida. Of the powers of 
the former we are entirely ignorant, having never prescribed it. 
Cullen, however, tells us that it is of no value. 

1492. The second, or artificial musk, has been long in use in 
spasmodic affections; and its powers are, in some degree, ascer- 
tained. But it is only within a few years that it has been em- 
ployed for the cure of pertussis ; and we have already said we 
have found it oftentimes a valuable remedy. 

1493. It is also highly estimated by Underwood; and espe- 
cially where the spasms are violent : it is given in the dose of 
five or six drops on sugar, or highly sweetened milk. 

1494. Of the antispasmodics, asafoetida has always borne a 
high character : but our own experience is by no means calcu- 
lated to advance the reputation of its powers in the disease in 
question ; though we have found it occasionally useful, but never 
decidedly efficacious. 

1495. We are next to consider the proper plan, after the cause 
of the disease, whatever it may be, has worn itself out, or is 
dismissed, and when the cough is kept up by the force of habit 
only : to interrupt the train of morbid associations, all the tonics 
have been directed, and especially such as are supposed to have 
the effect of subduing paroxysmal tendencies. The Peruvian 
bark was, of course, placed at the head of this class, and is much 
celebrated. Cullen bestows on it unqualified praise, and con- 
siders it by far the most certain means ; and even says, when 
given in sufficient quantity, he has seldom seen it fail of speedily 
putting an end to the disease. It is reasonable to suppose that 
the bark might be useful ; though it must be confessed that we 
have not witnessed such striking results from it; and, on account 
of the difficulty of getting children to take it with regularity, it 
is rarely prescribed in this city. 

or three hours during the night, should the cough be troublesome. One from six 
months to a year, a large tea-spoonful, and repeat, if necessary — one from one to 
two years, a dessert-spoonful, and repeat; one from two lo four, a table-spoouful, 
and so on. as the age increases. 



388 OF WHOOPING COUGH. 

1496. This objection, however, does not apply to the sulphate 
of quinine; and it deserves a fairer trial than we suspect it has 
received. We have employed it in only one case ; hut this was 
one of the most forlorn kind — it produced almost resuscitation. 

1497. Mr. SutclifF combined the bark with cantharides, and 
administered it with great success, he says ? in whooping cough, 
The following is his formula: — 

B=. Tinct. Cort. Perav. gvj. Take of the Tinet. of bark 6 ounces. 
Elix. Paregor. gss. Paregoric Elixir % ounce. 

Tfhet. Canthar. ^j. M. Tinct. of Canthar. 1 dram. 

Mix. 

Of this mixture, small doses were given three or four times a 
day, gradually increasing until a slight strangury was excited : 
and then the dose was diminished, or taken at longer intervals. 
The strangury would generally take place about the third day ; 
and the whooping cough seldom continued above six days from the 
first exhibition of the medicine. It, however, succeeded some- 
times without exciting any strangury, though it generally pro- 
duced its salutary effects sooner, when that circumstance came 
on, whether the bark was joined by the cantharides or not. 

1498. Dr. Lettsom says, that "'during twenty years this in- 
genious practitioner has almost constantly continued to use this 
medicine with the most flattering success." Dr. Lettsom being 
desirous to know whether Mr. SutclifTs more mature experience 
led him to place the same confidence in this remedy, wrote cer- 
tain queries to him respecting chin cough. 

1499. Mr. S. replied to these several queries, and concluded 
by remarking, "I never yet saw an unsuccessful event after using 
the composition of bark, cantharides, &c, having never lost a 
patient in the whooping cough." Dr. L. declares that similar 
success attended his own trials of this medicine. Watt, p. 282. 

1500. But we have never employed any remedy, of equal 
efficacy with the garlic in substance, to relieve the cough of habit, 
after whooping cough. We have very often used it, and we have 
rarely seen it fail. The objections arising from its smell are, 
however, very strong in the minds of some; so much so, that 
they cannot be prevailed upon to use it. But children of six or 
seven years of age, or even older, can very often be prevailed 
upon to eat it, and become after awhile very much attached to 
it. A child of six or seven may begin by taking a third of a 
common-sized clove, morning, noon, and evening; gradually in- 
creasing the dose, as the system becomes accustomed to its ac- 
tion. One of ten, may take half a clove three times a day; in- 
creasing it as may be necessary ; and so on for greater ages. 

1501. Desruelles again condemns us for the employment of 
the garlic, both externally and internally. Indeed, he goes so 
far as to say we "have a blind confidence in this substance." 



OF WHOOPING COUGH. 389 

This affects us not; and so long as we continue to experience 
benefit from it, we shall persevere in recommending it, under 
the restrictions suggested above; namely, in the absence of all 
febrile excitement, and where the cough appears to be perpetu- 
ated by habit. The following case is highly deserving of atten- 
tion : Miss M. W., aged twelve years, had the whooping cough in 
great severity, notwithstanding she was subjected to very active 
treatment in the early or inflammatory stage of the disease. It 
began in March, and the cough continued with great violence 
until July, at which time we were requested to prescribe for her. 
At our first visit we had an opportunity of witnessing two fits 
of coughing ; both of which spells exceeded in severity any thing 
we had ever seen. She was literally black in the face, and was 
threatened with immediate suffocation. These paroxysms were 
repeated frequently, especially during the day : they left her weak 
and exhausted; she lost flesh daily, and was so debilitated as 
scarcely to be able to walk. She was ordered to eat a small 
clove of garlic three times a day; in forty-eight hours these pa- 
roxysms left her entirely; a slight cough remained for a few days, 
and then ceased altogether. We cannot but believe it was the 
garlic which afforded such speedy and happy relief; particularly 
as it has frequently proved as certainly, if not as extensively, 
serviceable in other cases of whooping cough. 

1502. Exactly on the same principle, the arsenical solution is 
employed; and we have the strong testimony of Simmons and 
Ferriar in support of it. Each of these writers goes so far as 
to declare that it is the only medicine deserving of much confi- 
dence. On this point we can say nothing from our own experi- 
ence; as we do not deem the few trials we have given this medi- 
cine entitled to much weight : our impressions of its efficacy are 
not strong. 

1503. We have said nothing of the utility of topical remedies 
in the acute stage of the disease, for they can rarely be useful: 
but in the one now under consideration external applications may 
be advantageously resorted to ; such as liniments of an irritating 
nature, as the volatile, or the camphorated; the spirit of tur- 
pentine, mixed with olive oil ; or the juice of garlic, rubbed along 
the vertebral column. But, above all, we think we have observed 
more advantage to result from the use of the tartar emetic oint- 
ment, 1 than from any other external application — this should be 
applied high up between the shoulders. 

1 The following formula we are in the habit of using for children : — 

R. Tartar. Antimon. giss. 

01. Lavend. vel Ess. Lem. gtt. xv. 

Cerate Simp. §j. M. 

With this the part indicated must be rubbed three times a day, until it shows a 
number of small pimples upon it — dress with common cerate. 



890 OF CYNANCHE TONSILLARIS. 

1504. It is well understood how much the action of the lungs 
is dependent on a nervous influence from the spinal marrow ; and 
it is probably on this principle the efficacy of such embrocations 
is to be explained. The muscles of the chest, diaphragm, and 
scapulae, receive portions of the cervical and dorsal nerves; the 
accessory nerves of Willis form a part of the par vagum, and 
assist in giving rise to the cardiac and pulmonalic plexus ; hence 
the propriety of applications to the spine; and hence the popu- 
lar opinion of the utility of a Burgundy pitch plaster between 
the shoulders, is accounted for, from anatomical arrangement. 

1505. Of the efficacy of a change of residence, more particu- 
larly to the country, and even a frequent exposure to fresh air, 
every one is so fully persuaded, that the remedy is abused by its 
general and indiscriminate adoption. It is by no means uncom- 
mon to see children exposed in the coldest and most inclement 
seasons; and this, sometimes, by the orders of the attending 
physician. Nothing can be more pernicious and ill-judged. 

1506. In the inflammatory catarrh, we guard against cold by 
keeping the patient in a room duly warmed; the same should 
be observed in the first stage of the whooping cough. The lungs, 
in this case, are either inflamed, or peculiarly susceptible of in- 
flammation — so that the slightest exposure brings on, renews, or 
violently exasperates the attack. Catarrh, or active peripneu- 
monia, superinduced on pertussis, constitutes a most formidable 
case, and most frequently is the way in which the disease proves 
obstinate or fatal. But, the inflammatory stage having passed, 
and the weather mild, much advantage may be derived from gen- 
tle exercise in the open air — this may be by walking, or riding 
in a carriage. But, completely to eradicate the disease, the 
child should be removed into the country, provided the season 
of the year will justify this change. 



CHAPTER XXX. 



OF CYNAXCHE TONSILLARIS. 



1507. This disease comes on with huskiness, and next with 
pain and inflammation of the throat, attended by some difficul- 
ty of deglutition, and sometimes with fever. In a short time 
these are increased; and from the swelling of one or both ton- 
sils, there is a great inability to swallow. If the throat be 
examined at this time, we shall find the uvula, the pharynx, and 
the neighbouring parts extremely red, and excessively tender. 

1508. It, however, in some instances, and especially where the 



OF CYNANCHE TONSILLARIS. 391 

individual has had many preceding attacks, shows itself as a mere 
local affection, without fever, or any general constitutional dis- 
turbance. 

1509. In this form of the disease we have phlegmonous in- 
flammation, which terminates, usually, either by resolution, or 
suppuration, and sometimes by induration of the glands. But 
in other cases it puts on the appearance of erysipelas ; and here, 
instead of red vivid inflammation, with much swelling, the aspect 
is dark or purple; with superficial vesicles, or ulcers, of a white 
or gray colour, resembling ordinary aphthae. 

1510. Commonly, no species of this disease is dangerous, 
whatever may be the degree of the immediate suffering ; and it 
only becomes so, when the inflammation extends to a more im- 
portant structure, as the larynx. 

1511. The symptoms, however, sometimes run very high, and 
then great suffering is endured. For the tonsils become so en- 
larged and engorged, that they nearly fill up the posterior fauces. 
Deglutition is now extremely difficult, and sometimes altogether 
impossible, without a repetition of the greatest and most painful 
efforts. Under such circumstances, it is not unusual for cough 
to be excited, and drive whatever is attempted to be swallowed 
through the nostrils. The faucial extremities of the Eustachian 
tubes are very apt to be involved in this inflammation: when 
this is the case, each attempt to swallow is followed by an acute 
darting pain through the course of the tubes, which seems to 
terminate in the external ear. 

1512. One of the most troublesome symptoms against which 
the patient has to contend, is the free secretion of a very tena- 
cious mucus ; this quickly accumulates in sufficient quantity to 
force the patient to swallow it; on which attempt the pain be- 
comes so excessive as to produce a convulsive action of almost 
every muscle in the body. This secretion is particularly trouble- 
some when the patient attempts to sleep — so much so, indeed, 
sometimes, as almost to preclude the possibility. To obviate 
this as much as possible, the patient should make his mouth so 
depending, that it may flow out before it accumulates in such 
quantity as will oblige him to swallow. The whole of the mus- 
cles of the fauces and tongue partake so much of the inflamma- 
tion that it is impossible sometimes to protrude it ; and the effort 
is always attended with pain. The tongue is quickly incrustecl 
with a thick, very white coat. 

1513. The fever which accompanies the cynanche tonsillaris 
is sometimes very high; at others very much less than we would 
suppose would attend an inflammation of such extent and appa- 
rent violence. With those who are liable to attacks of sore 
throat, the fever for the most part is moderate — indeed, in some 
instances, it seems to decline in proportion to the frequency of 



392 OF CYNANCHE TONSILLAKIS. 

the occurrence, as if the system had lost some portion of its 
sympathizing powers. We, however, know of but few diseases 
which leave so much debility in the same time behind it. This 
may, perhaps, in part, be accounted for from the entire impos- 
sibility, sometimes, of taking down nourishment. 

1514. This disease is occasionally very obstinate; the inflam- 
mation not advancing to suppuration, nor receding by resolu- 
tion. This is especially the case with those who may have cy- 
nanche supervene upon enlarged tonsils; or in those who have 
the lymphatic temperament strongly marked. 

1515. Cynanche tonsillaris is almost exclusively produced by 
exposure to cold. There are many persons peculiarly liable to 
it; and a predisposition seems to be especially given by former 
attacks ; hence caution is required in avoiding the exciting 
cause. 

1516. The practice of washing the throat every morning with 
cold water, is said to be an excellent preventive, and we know 
that much advantage has been derived from gargling the throat 
every morning and evening with a solution of alum, for the same 
purpose. 

1517. The treatment of the disease divides itself into that 
which is proper in its forming state, and into that at the subse- 
quent stages. 

1518. If we are called very early, and before diseased action 
be completely established, we may frequently check the attack 
by a stimulating gargle — such as an infusion of Cayenne pepper ;* 
and by rubefacients, as the spirit of turpentine, mustard and 
vinegar, applied to the external surface of the throat, until the 
skin becomes inflamed; or even by warmth, when the attack is 
very recent and mild, as a piece of flannel, or a worsted stocking 
tied around the neck. But should these fail, we change the 
practice, and endeavour to reduce the inflammation by evacua- 
tions. An emetic is here exceedingly efficacious, generally re- 
solving the swelling, and suppressing the fever, if such exist: 
this should be succeeded by a mercurial purge, to be worked off, 
and the bowels kept open, by the saline laxatives. 

1519. If necessary, we must next resort to blood-letting, and 
especially leeching the throat; but the state of the pulse must 
always govern the use of these remedies. In many cases it is 
not at all demanded; particularly general bleeding, as it is 
rarely productive of as much utility as might be expected. Yet, 
where there is great vascular action, it must be employed, and 
repeated according to the emergency. The topical bleeding, by 
cups, or leeches, is generally more effectual; and especially 

1 Take a tea-spoonful of Cayenne pepper, pour on it a gill of boiling water, stir 
for a couple of minutes, and then let it settle clear — let the throat be gargled with 
a portion of it every four hours. 



OF CYNANCHE TONSILLARIS. 393 

where the affection is local, or the system is somewhat reduced. 
In violent cases, or even in cases threatening to be violent, blis- 
ters should be employed; and this as early after the leeching 
as possible. 

1520. Gargles, in this state of the disease, are always detri- 
mental; as they aggravate the inflammation by the violent and 
inverted action which they induce. As a palliative, a mixture 
of equal parts of nitre and loaf sugar, finely powdered, occasion- 
ally put on the tongue, and, as it melts, allowed to trickle over 
the inflamed surfaces, is oftentimes highly serviceable ; as is also 
the stream of water, or vinegar and water, applied by Mudge's 
inhaler, or, as a substitute, a common teapot. 

1521. But should the disease obstinately run its course to 
suppuration, (which may be known by the surface becoming of a 
yellowish hue, and by the throbbings and disposition to rigour,) 
they may, in urgent cases, be opened. With this view, emetics 
were formerly employed. But the practice is painful and unne- 
cessary, as it may be readily done by puncture. Having dis- 
charged the matter, mild detergent gargles, as sage tea, honey, 
and vinegar, should be directed, to cleanse the parts, and dispose 
them to heal kindly. 

1522. As regards the erysipelatous species of the disease, the 
treatment is somewhat different. We rely more on topical bleed- 
ing and the vesicatory applications ; and where aphthae or sloughs 
appear, on stimulating gargles; and, in the event of extreme 
debility supervening, the system is to be supported by bark, wine, 
the carbonate of ammonia, and whatever else enters into the 
treatment of putrid sore throat. 

1523. If due attention, however, be paid to the forming stage 
of this disease, it can very frequently be arrested in limine: for 
this purpose, stimulating external applications are, for the most 
part, efficient. The spirit of ammonia, of turpentine, or a mix- 
ture of the flower of mustard and vinegar, are the best. They 
should be applied immediately over the throat, and should be 
permitted to remain until they produce decided irritation : they 
maybe repeated when this effect disappears. 

1524. To such children as are subject to this affection the 
above directions are highly important; and subsequent returns 
may often be prevented in those who can gargle, by a perse- 
vering use of alum water, or an infusion of nut galls, in the pro- 
portion of half an ounce of the powder to a pint of boiling 
water, and then simmered for a few minutes. This must be 
strained off, and used early in the morning, and on going to bed. 
We have found the following better in warm weather than the 
one just suggested. Pour half a pint of brandy or whiskey, and 
as much water, upon an ounce of powdered Aleppo galls, and 
shake them several times a day for a few days — let it then settle, 



394 OF MUMPS. 

and pour off the infusion for use. With, a quantity of this the 
throat should be gargled the first thing in the morning, and the 
last at night. 



CHAPTER XXXI. 



1525. This disease consists in an inflammation of the parotid 
glands, of the phlegmonous kind. It is often confined to one 
side; though more generally to both; sometimes the maxillary 
glands are also implicated, and hence the swelling of the jaws. 

1526. For the most part, this is a disease of but little mo- 
ment, especially if it occur in the warmer season of the year. 
But at other times there is much constitutional disturbance. 
Rigours, followed by much fever, sometimes happen, especially 
during the variable weather of early spring. The first sensation 
of inconvenience is about the angle of the lower jaw: this part 
presently becomes painful upon moving the head: a tumour is 
now perceived at the part, which goes on to increase until the 
fourth or fifth day; after which it gradually subsides, if not 
maintained by fever. It is not unusual for one side to be first 
affected, and after this has nearly run its course, the gland upon 
the opposite takes on inflammation, and also runs its course. 
When this happens, the disease becomes more protracted and 
painful. 

1527. We have occasionally seen severe suffering from this 
complaint: this is in consequence of a high degree of inflamma- 
tion, and an excessive enlargement of the gland. The jaws be- 
come closed, and deglutition is performed with much difficulty. 
The ears are now and then much pained, as in common ear-ache. 
The stomach is sometimes annoyed by nausea, or disturbed by 
vomiting : and in some few instances we have witnessed exces- 
sive fever, and even delirium. 

1528. When this complaint is unattended by much fever, its 
progress is regular, and its termination favourable — in such case, 
it is scarcely an object of medical discipline ; at most, it requires 
but lenient purging, a low diet, and some mild topical applica- 
tions, as warm sweet oil, or hog's lard, and the pained parts kept 
warm by flannel. Care, however, should always be taken, even 
in the mildest forms of this disease, that the patient be not ex- 
posed to the risk of taking cold ; as a remarkable peculiarity at- 
tends this complaint, which is, its disposition to metastasis, or 
translation, to the' testes in males, and to the breasts in females; 
especially in adults. 



OF MUMPS. 395 

1529. In the severer forms, however, of this complaint, active 
measures are sometimes indispensable; bleeding to a consider- 
able extent we have occasionally found necessary; brisk purging, 
and the most strict observance of an antiphlogistic regimen. 

1530. Occasionallv we have been obliged to have recourse to 
topical depletion by leeches, and this followed by warm cata- 
plasms of bread and milk, to promote the farther discharge from 
the bites of these animals. The mercurial purges appear to 
answer best in this disease ; especially if their operations be 
promoted by either of the neutral salts. 

1531. Should a translation take place, it may be accompanied 
by many distressing symptoms. In the male, we once saw the 
testes prodigiously enlarged; much suffering was endured, and 
great hazard was incurred by the change. Violent fever and 
delirium accompanied this change of seat of the disease, and it 
required a perseverance in very active remedies to subdue them. 

1532. In the female, the breasts are the seats of the metas- 
tasis: they sometimes enlarge very much, and become extremely 
tender and painful; but we believe they never run on to suppu- 
ration. 

1533. In the treatment of this complaint, under a change of 
seat, regard should always be paid to the parts originally affect- 
ed. With this view, we have always blistered the parts imme- 
diately over the parotids, and, we think, with decided advantage. 
If the change have taken place in the male, we also exhibit an 
emetic, and apply warm vinegar by means of flannel to the 
scrotum, and this to be repeated from time to time. A brisk 
purging should also be instantly instituted, after the operation 
of the emetic is entirely over, provided it, and the blistering, 
have not been successful in recalling the morbid action to the 
original seat of the disease. 

1534. In females, besides blistering and purging, (for with 
them it is doubtful whether emetics are useful in this condition,) 
we apply warm vinegar by means of flannels, as directed above, 
to the inflamed breast. We have never seen any permanent 
evil follow these translations ; though several such are recorded 
by authors. 

1535. This disease, like several others, affects the system but 
once; it is supposed to be contagious; but whether this be well 
founded we are not prepared to say — it is almost always epide- 
mic, at least in this country; which may, with much propriety, 
call in question its contagious nature. 



396 of croup, 



CHAPTER XXXII. 



1536. It is not essential to our purpose to inquire whether 
this disease was known to the ancients, or is one of comparatively 
modern origin. It is now sufficiently ascertained that it is one 
of too frequent occurrence in this as well as in many countries; 
and, also, that it is one of too frequent danger. 

1537. This complaint is almost altogether confined to the 
period of childhood; and is most frequent in infancy, or before 
the fifth or sixth year. It is affirmed, particularly by Cullen, 
that this disease rarely attacks infants till after they are weaned ; 
and that there is no instance of its occurring in children above 
twelve years of age. As a general rule, this may be correct; 
but our experience has furnished us with a number of exceptions. 
We have seen it, in its most formidable shape, in children at the 
breast; and we have witnessed death from it in the adult. 1 

1 " The croup chiefly prevails in children from a short period after birth, until 
puberty, attaching itself to particular families. " Cheyne, p. [5. To the truth 
of these observations we have frequently borne witness. But we have seen this 
complaint after puberty, and in adult age, though Dr. Cheyne says, " I have heard 
of no example of this disease after the fifteenth year." He says, farther, "I have 
imagined this to depend on the change which happens in the constitution at puberty, 
and, perhaps, in a more peculiar manner, in the change which the upper part of 
the windpipe undergoes," p. 23. This is ingenious ; and, probably, it is owing 
to this circumstance that it is a rare disease in adult age ; but that it occurs even at 
late periods of life is certain. We have attended a lady within the last six years, 
who is now upwards of forty, several times, (certainly five,) with threatening 
attacks. M. Guibert is of opinion that " various anatomical and physiological 
circumstances concur in rendering the croup more frequent in infancy, and in giving 
it its distinguishing characteristics. The principal of these are; 1st, The straight- 
ness of the windpipe, and particularly of the glottis; 2dly, The great sensibility 
of the mucous system in general, of which sensibility the membrane lining the 
respiratory passages has its full share ; 3dly, The extreme difficulty of expecto- 
ration, at this age, a circumstance which favours the accumulation of mucus in 
the windpipe, and consequently the obstruction of the bronchial ramifications; 
4thly, the activity of the circulation, which readily explains the ready occurrence 
of inflammation at this period of life, as well as the intensity of their symptoms 
and the rapidity of their progress; 5thly, The abundance of matters furnished by 
the secretions and exhalations, particularly those of the cutaneous and pulmonary 
transpirations, and of the mucous secretions of the air passages; 6thly, The close 
sympathy which unites these latter functions, a sympathy which enables them 
mutually to support each other, and which occasions the increase of action in the 
one when the activity of the other is diminished; 7thly, The fineness and softness 
of the skin's texture, the light clothing worn by children, their imprudence in ex- 
posing themselves to cold when they are sweating profusely, and becoming sud- 
denly inactive after severe exercise." (Researches Nouvelles et Observations 
Pratiques sur le Croup et sur la Coqueluche, &c. p. 7.) 

As a prophylactic, we have been assured by Dr. Dupuy that ten drops of spirit 
of turpentine, morning and evening, have been f<jund by Dr. Mettauer highly 
serviceable. 



or croup. 397 

1538. Children of a florid complexion, and enjoying high 
health, and especially those inclined to be fat before two years, 
are more obnoxious to it than those of an opposite temperament. 
It is a disease of more frequent occurrence in some situations 
than in others ; and those which are near waters of great extent 
are more exposed to it than children in inland situations; in a 
word, where a cold and moist air unite ; and especially when it 
suddenly alternates with a dry, warm air. Nothing, perhaps, 
can be more satisfactorily proved, than the agency of cold, moist 
air, in the production of this complaint, especially in the spring 
and fall. So much so, indeed, is this the case in certain situa- 
tions, that the mothers of such children as may be disposed to 
this disease, dread the prevalence of that wind which shall bring 
with it both. Thus, in this city, a north-east wind in early spring, 
or fall, is almost sure to produce, or reproduce, this complaint in 
those who are disposed to it. But, with such, almost any sudden 
transition, which shall too suddenly arrest perspiration, will be 
attended by the same consequences. 

1539. Mechanical causes have produced a disease having all 
the characters of croup from other causes ; thus, Mr. Balfour 
informed Dr. Home that he had "attended a child in a disease, 
which from the similarity of voice appeared to him to be croup. 
The child died. When opened, a piece of shell, which the child 
had sucked in with its breath, was lying across the trachea, about 
an inch below the glottis, and the membrane was inflamed and 
dry." "Here," continues Dr. Home, "was an artificial croup 
raised, from which we may evidently perceive how the voice is 
altered in the natural disease." 1 

1540. This disease attacks in one of two ways: 1st, by a 
hoarseness, which is perceived upon coughing, and which may 
continue without increase, for even several days, or until, per- 
haps, the sudden application of some exciting cause, as a change 
in the temperature of the air. For exposure to cold and damp, 
or a check of perspiration, is sure to call forth some of its more 
formidable symptoms ; as more or less difficulty of breathing ; 
an increase of cough without expectoration, and fever: this form 
is longer running its course than the one about to be mentioned, 
but is less obedient to the powers of medicine. 

1541. Or, secondly, it may attack with the most alarming 
suddenness, where no such onset was suspected. When it is thus 
prompt in its appearance, it menaces life from the moment of 
its invasion ; and if its terrible march be not very speedily ar- 
rested, it but too frequently triumphs in death. 

1542. But whether the croup insidiously steal upon its victim, 
or suddenly threaten it; the latter part of the evening, after a 

1 Inquiry into the Nature and Cure of Croup, p. 49, 



898 or croup. 

short, but rather disturbed sleep, and about two or three o'clock 
in the morning, are the most certain periods for it to declare 
itself — hence the frequency of our first attendance during the 
night. 1 

1543. With the exception of hoarseness, we have never ob- 
served any premonitory symptoms to this disease; for we cannot 
with propriety consider a slight catarrhal affection as properly 
belonging to this complaint, though it may occasionally precede 
the croupy symptoms. Cheyne's account is rather too poetical 
for ordinary occurrence; or, at least, we cannot acknowledge 
we have ever witnessed, (and our own family has furnished us 
unfortunately with but too many examples,) that the patient 
" shuns his play fellows, and sits apart from them, dull, and, as 
it were, foreseeing his danger," p. 16. On the contrary, we have 
seen many instances where this disease has attacked children, 
and that with great violence, after their having spent an evening 
in high mirth and merriment. 

1544. It must, however, be confessed, that we have known 
children indisposed, and dull, from catarrh, previously to the 
attack of croup ; but, in these instances, the latter was not an- 
ticipated from any of the then existing symptoms ; consequently, 
this previous condition did not necessarily belong to, nor, strictly, 
precede the latter. We believe it to be familiar to almost every 
practitioner, that croup may supervene upon catarrh; not, perhaps, 
ever as a consequence, but as a coincidence ; for catarrh is owing 
to a peculiar condition of the mucous membrane of the nose and 
windpipe; and that croup may form, or grow out of this affec- 
tion, it will at least require an alteration of that condition, and 
not a mere increase of its force ; for in the severest catarrhs, 
we witness — catarrhs, w r hich require not only prompt, but ex- 
tremely active treatment, croupy symptoms do not make their 
appearance, as a necessary consequence. In this opinion we 
are happy to find ourselves confirmed by an observation of the 
celebrated and accurate Laennec, whose work upon the diseases 
of the chest has been lately most ably translated by Dr. Forbes. 
He says, p. 120, " The false membrane which so frequently forms 
on blisters is, of itself, sufficient to prove that it is much less to 
the degree than the nature of the inflammation, that we are to 

'Dr. Cheyne says, "The disease generally comes on in the evening, after the 
little patient has been much exposed to the weather during the day, and often after 
a slight catarrh of some days' standing." p. 15. The evening is the most frequent 
period for an attack of this complaint; but for this purpose, it is not necessary that. 
" the little patient" shall have been "much exposed to the weather;" for we have 
often witnessed this disease from the mere prevalence of a north-east wind, and 
where, in consequence of this wind, every precaution has been taken to guard 
against its influence, by confining the child, and keeping it warm. We have else- 
where declared, (1544) that catarrh is not a necessary forerunner of this com- 
plaint. 



of croup. 399 

attribute this concretion or coagulation of pus in certain cases. 
Indeed, the cause of it is much more probably to be attributed 
to some peculiar disposition of the fluids, than to any affection 
of the solids." 

1545. From this it would appear that it is not sufficient for 
the production of croup, that the mucous membrane of the wind- 
pipe be merely inflamed ; but that it requires a modification of in- 
flammation to induce it. 

1546. It may be farther observed that during the prevalence 
of catarrhal affections croup is more rife than at other periods ; 
not that the one produces the other (1544;) but because, during 
such periods as the spring and fall, or the very moist and open 
weather of winter, there is a stronger disposition created to these 
diseases ; and that they have, at one and the same time, the 
same exciting causes. 

1547. We have uniformly observed the insidious approach of 
this complaint to,be less under the control of remedies, if its first 
stage be neglected, than when the attack is sudden, however vi- 
olent that attack may be. This is doubtless owing to its first 
symptom, hoarseness, being neglected. Tor this reason, we would 
wish to put parents upon their guard, whenever this symptom 
may take place; and to assure them, from long experience, that 
it is one of a most dangerous and threatening character. So at- 
tentive have we been to this forewarning in our own family, (and 
we have taught others to be equally vigilant,) that this symptom 
was attended to immediately, and opposed by most active reme- 
dies ; and we have every reason to believe, that by the means 
recommended for this purpose, we have stopped this formidable 
complaint in limine, in very many instances. It is true a hoarse- 
ness passes off sometimes without much mischief; but this is not 
the hoarseness of croup ; for this, we believe, never takes its leave 
spontaneously. 

1548. The hoarseness which disappears spontaneously is very 
distinct from that of croup ; the difference, however, cannot well 
be conveyed by words, unfortunately sometimes for those who 
may be assailed by it. 1 This, however, may be observed, that 
there is a certain clearness and distinctness in the croupy 
sound, that does not attend the other; the one, (the croupy) 
seems as if it issued from a metallic instrument ; and the other 
from one of a less vibrating material. The ear, however, by 

1 Dr. Ferriar observes, (Med. Hist. Vol. III., p. 137,) " Children who are subject 
to croup are sometimes seized with a deep barking cough, which will increase to 
such a degree as to create much alarm, about the usual time of the dangerous ex- 
acerbation ; yet it will decrease again, and at length go entirely off without any 
other remedies than common demulcents. Cases of this kind, I suspect, have 
been described as genuine paroxysms of croup; and very trifling methods of cure 
have been recommended, in consequence of their apparent efficacy in the spurious 
croup, which always cures itself. ,; 



400 OF CROUP. 

long habit, may learn to distinguish between them ; and when 
once instructed in this discrimination, never loses its tact. — 
Again ; we may observe that the evanescent hoarseness is almost 
always accompanied by a little soreness of throat ; while that of 
croup, we believe, never is. Again ; the first is perceived in com- 
mon speaking; whereas that of croup is only discernible, in 
the commencement, by coughing. Lastly, some little pain and 
soreness are observed about the posterior fauces, after coughing, 
in the one ; which never happens in that of the other. It may 
not, however, be amiss to observe, that a mere loss of voice must 
not be mistaken for croupy hoarseness, as we have known it to 
be on several occasions, to the great terror of an anxious parent. 

1549. In this, and, perhaps, in every other country where 
croup is of frequent occurrence, every sudden difficulty of breath- 
ing, accompanied with cough, in children, is mistaken for it. — 
Thus the acute pituitous catarrh is mistaken for it. Laennec 
says, " This disease is characterized by an extreme oppression, 
attended by a copious pituitous expectoration. It sometimes be- 
gins as a common cold ; but after a few hours, or even minutes, 
its severe character is soon declared by the violence of the cough, 
the intensity of the dyspnoea and oppression, the lividity of the 
face, marks of cerebral congestion, disordered circulation, and 
coldness of the extremities. In children it is sometimes mis- 
taken for croup." 1 

1550. But it may be proper to advise, whenever hoarseness 
takes place, not to trust too much to the discriminating powers 
of the ear, for its nature ; but instantly to proceed upon the sup- 
position that it may be of a dangerous kind; especially as the 
remedies employed for the one will most certainly relieve the 
other. It would, therefore, be erring on the right side, were we 
to treat this hoarseness as if it were of a mischievous character, 
though it might have passed away without such treatment. 

1551. It would seem necessary to the well understanding of 
the progress of croup, and its mode of treatment, that it be 
divided intoJ;hree stages; 2 1st, the forming stage; 2dly, the 
completely formed stage ; and, 3dly, the congestive stage. 

1 Laennec on the Chest, Forbes' translation, p. 80. 

2 Dr. Cheyne divides this disease into but two stages: 1st, "The incomplete, 
or inflammatory ;" and, 2dly, "the complete, or purulent." In the first, " the 
membrane is not yet formed, in the second, it is fully formed." This division does 
not comprehend the whole history of the disease; for the forming stage is one of 
the greatest importance in the treatment of the complaint ; and, therefore, merits, 
we conceive, the distinction we have given it. Besides, we cannot regard Dr. 
Cheyne's second stage as representing this disease in its complete form : since the 
whole of the phenomena of that stage are but consequences of the previous, or his 
" incomplete, or inflammatory." And he himself admits this, in several places of 
his lucid and excellent essay. M. Guibert divides the disease into, first, the stage 
of irritation; 2dly, that of albuminous secretion; and, 3dly, that of suffocation or 
debility. 



OF CROUP. 401 

Of the First Stage. 

1552. We have already remarked (1548) that one of the first 
and most certain signs of this complaint being about to take 
place is a peculiar sonorous hoarseness, when the patient coughs, 
but which at this period does not affect the speaking voice : this 
peculiarity exists for a longer or shorter time, without much in- 
crease, even for several days, in some instances; while in others 
the interval, or stage of formation, is very short, but very de- 
cidedly marked. This hoarseness may in some instances be ac- 
companied or preceded by catarrhal symptoms, (1544) but not 
necessarily. 1 In this stage, when not attended by catarrh, we 
find, for the most part, the circulatory system undisturbed, and 
the respiratory not confined, nor even hurried. The child, ge- 
nerally, is as cheerful as usual; and its appetite and digestive 
powers are undisturbed. In a number of instances, where the 
disease was making an insidious attack, we have seen children 
exert themselves even pretty violently without creating any un- 
common hurry in the breathing, or occasioning the slightest em- 
barrassment in it; yet these very children, in the course of a 
few more hours, were reduced to the last extremity; and some 
of them did not escape with life. 

1553. We think we have observed, however, in this forming 
stage, especially in the insidious attacks, the hands to be more 
than usually cold; the face to be rather unnaturally pale; and 
the skin to resemble, in a small degree, the cold stage of an in- 
termittent, but not attended by a sense of cold: this state of 
collapse remains for several hours, in some instances, before the 
system is roused to reaction. But where the attack is sudden, 
we are by no means certain that this condition always precedes 
the febrile state, which so frequently is awakened, and made to 
accompany this complaint. 

1554. During this period, however, the mucous membrane of 
the nose is observed to be affected ; since the secretion in the 
nostrils is either arrested altogether, or very much diminished; 
and continues to be so during the whole course of the disease, 
unless it terminate favourably. The cough is short, dry, and 

1 " The inflammatory affection of the larynx is, doubtless, sufficient to account 
for the alteration which takes place in the sound of the voice and cough." Cheyne, 
p. 22. We believe there is, in most instances, an intermediate condition of the 
larynx, in the commencement of this disease; which is a degree of excitement in 
the part, accompanied by a little thickening of the mucous membrane, but which 
do not absolutely amount to inflammation : for, could not hoarseness be produced 
by any thing short of inflammation, there could not be that species of croup, which 
Dr. Ferriar, and Dr. Cheyne himself, admit the existence of, namely, the "spu- 
rious croup." (See note to par. 1548.) We are farther disposed to believe in 
this condition of the trachea, or larynx, in consequence of the very speedy removal, 
in many instances, of this symptom, when sufficiently promptly attended to, by 
the remedies recommended for the first stage of this complaint. 

26 



402 OF CROUP. 

sonorous; or, if any thing be expectorated, it is thin and whitish, 
and in very small quantities. If the throat or fauces be inspected, 
nothing unusual, (at least, as far as we have observed,) shows 
itself. The back part of the tongue is, perhaps, rather more 
loaded than is natural, but it is far from being remarkable. 1 

1555. After the continuance of the above symptoms for a 
longer or shorter time, a change takes place by an aggravation 
of all of them; and, at the same time, others are added; and 
these will constitute the 

Second Stage, or that in which the Disease is completely formed. 

1556. "We now observe the hoarseness to be increased, and to 
affect the speaking voice ; 2 that is, the tone of hoarseness is evi- 
dently deeper, more ringing, and betrays itself in every attempt 
to speak; the cough is more frequent, the spells longer, and a 
degree of exhaustion, attended by an increase of the difficulty 
of breathing, follows each effort; the face becomes flushed during 
the coughing; but generally subsides as the circulation becomes 
more equal, after the exertion, but leaves the cheeks, or, perhaps, 
only one, redder than natural. 3 The circulation is now much 
hurried in most cases; at other times it is very little disturbed: 
when this latter is the case, the face is seldom flushed, and the 
hands and skin of the extremities are rather below the natural 
standard of heat. The child is drowsy, and falls into frequent, 
but disturbed slumbers, from which it is generally roused by the 
most heart-rending cough, and an increase of oppression. The 
child raises itself up, if sufficiently old to do so ; or, if not, ele- 
vates its head, with a desire to gain air more freely. This state 
of things does not last long; for, if the progress of the disease 
be not arrested here, it marches with rapid haste to the 

1 " When, in the urgency of the attack, the fauces and neck are examined with 
a view to investigate the cause of the symptoms, (hoarseness, &c) even when a 
sense of heat is complained of in the throat, the tonsils are not swelled, and but 
little inflamed," Cheyne, p. 18. 

3 It may be remarked, as a general rule, that where the voice becomes suddenly 
affected by hoarseness, which discovers itself in speaking, and without being so 
in coughing, that it is not the hoarseness of croup. This kind of hoarseness, how- 
ever, is more common to adults than to children. 

3 We believe there cannot exist a doubt of the condition of the mucous membrane 
of the trachea at this time — every thing would seem to declare it to be in a state 
of active inflammation. The formation of a deciduous membrane, which is some- 
times thrown up, or after death proved by dissection to exist, and even the remains 
of turgid vessels in this part, all announce inflammation of an active kind to con- 
stitute the approximate cause of this disease. 

The following is Laennec's "Anatomical Characters" of croup: "Croup is an 
inflammation of the mucous membrane of the air passages, with exudation of plas- 
tic pus, (coagulable lymph,) which becoming concrete at the very moment of its 
formation, lines the (inner?) surface of the membrane to a greater or less extent. 
When this false membrane is removed, the subjacent tunic is found of a deep vivid 
red colour, occasionally livid, and somewhat thickened," p 119. 



OF CROUP. 403 

Third or Congestive Stage. 

1557. At this period the cough is attended with some expec- 
toration of a thin, or frothy mucus, which affords no relief: it is 
more frequent in its recurrence, and more permanent in its dura- 
tion; sometimes so much so as to threaten strangulation — the 
child becomes much exhausted by these efforts, and throws itself 
back as if in despair ; but from which it instantly springs, from 
the feeling or dread of instant suffocation. It cannot now lie 
down; and it either throws its head much in advance, as in 
asthma, or bends its head very much backward; or it finds no 
relief but in a supine position, and that, apparently, the most 
unfavourable to easy breathing. It is restless in the extreme, 
and alternately tries every position without finding relief from 
any. 

1558. The face is no longer flushed; a dark lividity takes its 
place, which sometimes spreads itself even to the neck; the lips 
partake of this change, and the gums become pale and white, 
while the tongue is not unfrequently blackish, as if the blood 
were retained in it by a ligature. The forehead becomes shining, 
and the skin looks as if it were tightly stretched over it — it is 
wet with cold perspiration, as is now, indeed, almost every part 
of the body. The pulse is small, frequent, fluttering, and con- 
tracted. The heart beats with violence, nay, sometimes audi- 
bly. The auxiliary muscles of respiration are now called into 
requisition, and this process seems only maintained by their aid: 
a deep hollow is made immediately below the xiphoid cartilage, 
most probably by the severe contraction or efforts of the dia- 
phragm ; and the action of the heart is distinctly seen, even at 
a distance from its seat. 

1559. Though the cough is now more frequent, and the op- 
pression much increased, the hoarseness is neither so great, nor 
so sonorous. It is now almost a loss of voice, and the child, 
when it speaks, seems to employ for this purpose a loud whisper. 
Even when it coughs, the voice is less harsh ; or rather it has 
lost, in a degree, that appalling, brazen, vibratory sound, with 
which the first two stages are attended. This change of tone 
has but too often misled the inexperienced ear to a belief that 
the disease was yielding; and thus has given rise to hopes that 
but too soon are forever blasted. 

1560. Thirst, oftentimes, becomes so intolerable, as to render 
the demands for drink both frequent and clamorous, though every 
attempt to gratify be apparently at the risk of suffocation. The 
countenance is now anxious beyond expression; the eyes become 
piercingly brilliant and beseeching — they eloquently implore a 
relief which neither affection nor science can afford; and the 
poor sufferer expires, with a look full of supplication and anguish. 1 

1 We have sometimes seen, a short time before death, the little patient lie on 



404 OF CROUP. 

1561. This disease runs its course variously; sometimes it lin- 
gers for days, while at others its career is finished in a few hours. 
This variety in termination will depend upon the constitution; 
upon the period at which remedies were applied; upon the na- 
ture of the remedies, and their power or influence upon the sys- 
tem. 

1562. Dissection proves that this disease, in many instances, 
kills by suffocation, from a mechanical cause ; at other times, no 
such obstruction can be found — therefore, pathologists declare 
spasm to be the cause, where the mechanical one is not present. 
This, by some, has been extended even to the formation of a 
distinct species of croup; namely, the spasmodic; a kind we 
have never witnessed. By others this has been modified, and 
the pathology of croup made to consist in inflammation and 
spasm united. We do not believe in the presence of spasm, in 
either of the first two stages of this complaint; ft may take place 
and probably does sometimes in the last. "Dr. Marcus, of Bam- 
berg, in Bavaria, looks upon all fevers as inflammation of some 
one organ or other, and, as entirely seated in the arterial sys- 
tem, regards croup as a local inflammation alone, utterly inde- 
pendent of spasm, which neither exists here, nor in fevers of any 
kind." 1 

1563. Some have disputed the formation of a membrane with- 
in the trachea; but it can only be by those who are not in the 
habit of investigating diseases by dissection — we have seen it 
more than once, and, of course, we are convinced of its existence. 
Others, who will not venture to deny the presence of a fo- 
reign body within the trachea, deny it to be a membrane ; — 
they declare it to be nothing but inspissated mucus, and not a 
membranous product. At this day, there can be nothing new 
in the declaration, that if lymph be poured out from vessels in 
a certain state of action, upon either exposed surfaces or within 
cavities, that it will form membrane; the pleura and the peri- 
toneum furnish almost daily examples of this kind. 2 This mem- 
brane extends from below the larynx to the bronchial ramifica- 
tions; and we once saw it within them. 

its back, apparently resigning itself to a fate against which it could no longer 
struggle, and eventually expire, and that with a complacency that would create 
a hope that its sufferings had terminated even before death had relieved them. 

'Good's Study of Medicine, Am. Ed. Vol. 2d. p. 235. 

a When this substance is chemically examined, " the secretion appears to consist 
chiefly, if not entirely, of the gluten or coagulable lymph of the blood, diluted with 
its serosity, and copiously combined with that peculiar substance of the blood 
which has received the name of fibrin." — Good's Study of Medicine, Am. ed. Vol. 
2d. p. 234. Guibert says it consists of albumen. 

" It is a little singular that children should be chiefly subject to its attack, at 
whose age fibrin is not peculiarly abundant, and whose blood contains compara- 
tively but a small portion of azote, which in fibrin is so large a constituent." — 
Ibid. 



op croup. 405 

1564. Laennec, p. 120, says, "The false membrane of croup 
corresponds exactly with the form of the canals which it covers. 
Its thickness is usually somewhat greater in the larynx and tra- 
chea than in the bronchia, and varies from less than half a line 
to a line. Its consistence is that of boiled white of egg, but this 
usually diminishes towards its extremities, so that it becomes 
sometimes, in this situation, scarcely more solid than the thick 
phlegm of catarrh. It is of a white colour, with sometimes a 
shade of yellow, and is almost entirely opaque." 

1565. From what has been said, it will be evident, that nothing 
but the use of very efficient remedies can arrest the progress 
of this disease ; and for them to be availing, they must be em- 
ployed sufficiently early to prevent the inflamed lining of the 
trachea from relieving itself by effusion. For when this happens, 
the case, for the most part, is hopeless ; though some few instances 
have occurred where recovery took place after its formation — but 
their rarity only shows the little we have to hope at this stage, 
and the importance of early attention to this disease. 

1566. It is now so generally admitted that this is a local dis- 
ease, and one consisting in an active inflammation of a highly im- 
portant part; that there is scarcely any dispute as to the general 
mode of treating it, though there may be some variety in the de- 
tail, and the agents intended to fulfil the same obvious indica- 
tions. Therefore, with a view to the better illustrating the par- 
ticular mode of treatment, we shall follow the stages we have 
made this disease to consist of, and shall begin with the mode of 
treating the 

First Stage, 

1567. If due attention were paid to the timely application of 
appropriate remedies in the forming stage of croup, we have 
every reason to believe that this complaint could be stopped in 
limine, in nineteen cases out of twenty. It is to the ignorance 
of what a hoarseness may lead, that this obvious and almost cer- 
tain symptom, when it first manifests itself, is neglected; and 
to this neglect must be attributed the too often fatal termination 
of croup. 

1568. A sufficient experience justifies the declaration just 
made; and the same experience will, we trust, screen us from the 
imputation of becoming alarmists, when we declare that no hoarse- 
ness in children can be neglected but at the risk of life. We can 
call to mind but too many instances of fatal issue, where this 
friendly warning was unheeded, because its tendency was not 
understood. Our anxiety to abridge the ravages of this terrible 
disease has led us to dwell upon this point longer than would be 
necessary for the mere medical reader ; but we hope he will ex- 
cuse us for our cautions, which, though not necessary to him, 



^03 or croup. 

may be very important to others, who may honour this work with 
a perusal. 

1569. It has been our misfortune to have witnessed but too 
much of this disease; and, unhappily, too much in our own im- 
mediate family. We were early instructed in all its phenomena ; 
and but too sorely taught its deadly tendency. Our misfortunes 
made us more than vigilant — made us tremblingly apprehensive 
to every thing connected with this disease, especially its forma- 
tion. 1 But, perhaps, we have derived advantage from our losses ; 
and most happy shall we be if they can be made subservient to 
the general good. 

1570. For many years nothing could exceed our horror when 
called to attend a case of croup — for our too faithful ears could 
not forget the appalling sound of the breathing; alas ! they were 
instructed by instances of such endearment that memory was 
almost a curse. 

1571. We were thus forced to a knowledge of the rise, pro- 
gress, and issue of croup — would we could add, we were equally 
well instructed in its management — to this, however, we make 
no particular pretensions ; though we think we have arrived 
at some certainty in arresting its march. Our particular horror 
of croupy hoarseness led us, necessarily, after a time, to the 
very early application of remedies for its removal — hence, for 
the last twenty years, we have never suffered it in our own fa- 
mily to exist a single hour without an attempt to stop it. 

1572. As this disease most commonly attacks in the night, 
(1542) we have ever at hand the remedies about to be mentioned, 
that not a moment may be lost in their application. It is, there- 
fore, our constant habit, the instant we observe the croupy sound, 

1 The ear of one who has lost a child with this complaint becomes so extremely 
sensitive, that it instantly gives the alarm as soon as a hoarseness is perceived; 
and sometimes leads to an interference that would, perhaps, not be justified upon 
any other occasion. To illustrate this, and to show how the feelings may be im- 
pelled, under such circumstances, we will relate an anecdote which befell ourselves. 
Passing a house, towards evening, in one of our streets, our ears were assailed by 
a hoarse cough, which proceeded from a shivering little boy of about three years 
old, who was at the door, but which was shut against him. 

He appeared very cold : it was a drizzly evening, and the month was November. 
At this time, our loss of an only child with croup was recent; and we were la- 
bouring under all the wretchedness such a loss could inflict, and of course were 
peculiarly sensitive to everything which reminded us of a disease which had cre- 
ated for us so much misery. We knocked at the door, and begged to see the mo- 
ther of the child: the person before us proved to be the one we wished to see. 
We represented to her the dangerous situation her little boy appeared to be in, and 
begged she would immediately send for her family physician, to visit the child, 
advising, at the same time, what we judged proper to be done, until he should ar- 
rive. The mother laughed at our fears ; and said it was nothing but a little cold 
the child had taken, and declared he would be well enough in a day or two, " with- 
out any doctor stuff." 

We took our leave; but feeling interested for the child, we went next day to 
inquire for him ; and was told by a next door neighbour that he had died early that 
morning of »' hives :" — our feelings can be better imagined than described. 



OF CROUP. 407 

to inflame the external throat by the application of the spirit of 
turpentine, hartshorn, or mustard and vinegar. This we repeat, 
if the first have not subdued the hoarseness, as soon as the rube- 
facient effect has subsided ; for it may be proper to observe, we 
do not carry the stimulation to blistering. In aid of these ex- 
ternal applications we administer, in doses suitable to the age of 
the child, "the compound syrup of squills," or Coxe's hive syrup, 
as an expectorant, or, if necessary, as an emetic. 

1573. If the hoarseness do not yield to the turpentine, or to 
expectorant doses of the syrup, we urge the latter, by quickly 
repeating the dose, to an emetic effect; but this is rarely neces- 
sary, if the complaint have been taken early, or if the throat 
have been well inflamed. For we can most truly declare, we 
have very often seen this disease subdued in an hour or two. 
But should the hoarseness not disappear, though much diminished, 
we continue the use of the syrup, until it does. Should the 
bowels be confined, we give a dose of castor oil, in aid of the 
general intention. 

1574. With the same intention we regulate the diet — or rather 
make it consist of barley water or flax-seed tea: we confine the 
patient to an atmosphere of moderate temperature, and most 
sedulously guard him against exposure, or a draught of air. 
The throat must be protected by a piece of flannel, or some 
other warm covering, after the turpentine or mustard has been 
removed. 

1575. It is truly astonishing with what certainty this plan 
arrests the disease, in by far the greater number of cases. An 
experience from very many instances fully justifies our commen- 
dation of it. We, therefore, earnestly advise every mother, and 
especially those who may have children subject to this complaint, 
to have immediately at command the articles just mentioned, and 
to employ them, as just directed, the instant hoarseness may 
appear. If this be faithfully attended to, we shall rarely have 
an opportunity to prescribe for 

The Second Stage. 

1576. It may, however, happen, that the plan just suggested 
may not be availing ; that the proper time for their application 
has been lost ; or that we have not seen the patient until the 
second stage has been completely formed: in either of these 
events we are obliged to prescribe for the case as it presents it- 
self. We shall find the system in the second stage (1556) in 
one of two conditions : namely, 1st, where the disease is com- 
pletely formed as regards the state of the trachea; but without 
the arterial system being much affected: or, 2dly, where the 
action of the arterial system is much exalted, in consequence of 



408 OF CROUP. 

the inflammation of the trachea. These two conditions, in our 
opinion, require some difference in the mode of treatment; and, 
first, of that condition where the blood-vessels of the system at 
large are not much affected. 

1577. In this case, the force of the disease is mainly spent 
upon the organs immediately concerned in respiration; hence 
the cough is more frequent, nay, sometimes almost incessant; 
the hoarseness less deep, but more sonorous and vibrating; no 
expectoration, or in a very trifling degree, and that of uncon- 
cocted serum, the discharge of which affords no relief. The 
face, for the most part, rather pale, or partially flushed; the 
nostrils very dry ; the hands and skin generally rather below the 
natural standard; the eyes somewhat blood-shotten ; the pulse 
frequent and small, and the respiration laborious, and every 
hour becoming more and more so. 

1578. In this situation we have thought the remedy so exclu- 
sively relied upon by many, namely, blood-letting, always in- 
jurious, or certainly never beneficial — we, therefore, cannot, 
agreeably to our present impressions, recommend it; since, under 
such circumstances, we never now employ it, either generally or 
topically. We always commence the treatment by the stimulating 
applications (1572) to the throat ; and quickly administer a brisk 
emetic of the tartrite of antimony; or, should it be immediately 
desirable to procure evacuations from the bowels, we combine 
with it liberal doses of calomel, according to the following for- 
mula, for a child of two years old or rather more. 

R. Tartrite of antimony gr. ij. 
Calomel prepared gr. xij. 

These to be intimately mixed, and divided into eight parts — one 
of these to be given every twenty minutes, or half hour, mixed 
in a little thin syrup, until an emetic and cathartic effect be 
produced. Should it prove pretty powerfully emetic, we make 
the intervals longer ; that is once in an hour, and more seldom, 
in proportion to the effect, until the bowels be freely moved, or 
even purged. 

1579. After the medicine has operated freely, we order the 
hive syrup in suitable doses, (1572) every half hour, or hour, or 
more seldom, as the effect may be more or less ample. Should 
the disease not have yielded to this discipline, we give calomel 
in pretty large quantities, every two hours, as long as the bowels 
will bear it without being too much purged ; always recollecting 
that the expectorant doses of the hive syrup are not to be dis- 
continued, unless there be much nausea. 

1580. If the above remedies make a suitable impression upon 
the disease, an abatement of all the unpleasant symptoms will 
take place, and give us some assurance of a favourable issue. 
In the condition of the system now under consideration we 






OF CROUP. 409 

must not neglect to observe that we reckon among the favour- 
able signs, a greater warmth of skin, with a slight disposition to 
perspiration, and an increase of force and vigour in the circu- 
lating system ; for when these take place, there is less risk of its 
running on to the congestive stage, or at least this period is de- 
layed. Besides, this change is an evidence of the disease being 
now less concentrated, and that the system can now bear farther 
depletion with advantage, should it be judged necessary. This 
is so decidedly the case sometimes, that we can, with much profit 
to our patient, abstract blood, either from the system generally, 
or from near the parts, by cupping. In a word, the disease is 
now converted into the second condition, or where the arterial 
action is much exalted. 

1581. In this second stage of the disease, the symptoms are 
rarely so appalling as in the first, though of the same general 
character. The disease is less masked, and we, consequently, 
have a more open enemy to deal with. In this condition, we 
almost exclusively rely upon blood-letting to make a first and 
favourable impression ; and there are few who have not witnessed 
with what promptitude and success this is sometimes effected. 
The bleeding, to be successful, must be carried to a sufficient 
extent; that is, until it make a decided impression upon the 
pulse ; or until it flutter under the finger, or a disposition to syn- 
cope discover itself. 

1582. Some have advised that the blood should be drawn from 
the jugular vein ; there may be an advantage in this, that our 
present experience does not recognise: certain it is, we should 
not hesitate to select this part, were we left entirely to ourselves, 
since its nearness to the diseased parts would lead to the belief 
that they might more certainly and speedily be relieved by it. 
But to make choice of this vein as a general rule to bleed from, 
we should have to contend with much prejudice; more, perhaps, 
than the selection is really worth — but at the same time we 
would recommend that this part should not be lost sight of, in 
certain ferocious cases, where life may depend upon the differ- 
ence of influence that the bleeding from one part, rather than 
from another, may produce. 1 

1 A late writer, Mr. Goodlad, (North of England Med. and Surg. Jour. No. 2) 
says, "From what has already been said, it is evident that two indications are 
necessary to be attended to in the cure of croup; the first is to subdue the inflam- 
mation of the windpipe, the other to relieve the oppressed circulation. Unless 
the first object be attained, no means will avail; nor will it in every case be safe 
to wait until that can be accomplished, before we relieve the system at large. 
Danger may be imminent from either of these causes, and we have often to deter- 
mine whence it is most so, and to regulate our practice accordingly. 

"The causes which produce croup, its symptoms and progress, alike indicate 
the necessity of blood-letting, and this remedy, in comparison with which all 
others sink into insignificance, should be immediately resorted to. Any quantity 
of blood may be drawn by leeches, and the local complaint, in almost all cases, 



410 OF CROUP. 

1583. The repetition of the bleeding must be governed by 
circumstances ; for bleed we must, in some cases, again and again, 
if the system react with force, and the pulse be found of diffi- 
cult reduction. But here we would wish to caution the inex- 

be subdued by them; for if one crop of leeches do not remove it, others must fol- 
low, until the breathing become free, or the child so faint that farther depletion 
would be unsafe. This mode of taking blood, by emptying the vessels, which 
are inflamed, will, it is evident, afford relief, with least expense to the constitu- 
tion; but when the complaint has existed many hours, and the jugular vein be- 
comes alternately distended and collapsed, during each inspiration; when the 
angles of the mouth are drawn downwards, every muscle of the neck brought into 
action, and the breathing consists of a series of gaspings, there will not be time 
afforded for leeches, and not a moment must be lost. The external jugular vein 
should be immediately opened with a lancet, though this operation is sometimes 
exceedingly difficult, requiring a quick eye and a steady hand to catch it between 
each inspiration. The struggles of the patient, and the great contraction of the 
muscles, add to the difficulty : but no consideration should deter us from giving 
instant relief, and no other method of taking blood seems to afford the same im- 
mediate benefit both to the head and breathing. The child may be on the brink 
of effusion, and every minute lost is matter of serious reproach; but this urgency 
of the case, which, if not attended to, will speedily be followed by stupor, and 
that loss of sensibility over the whole frame, so favourable to effusion, renders 
additional precaution necessary; for if the depletion be carried too far, or the 
vessels emptied very suddenly, that event, so much to be dreaded, will be ac- 
celerated. 

" The finger should therefore be kept upon the pulse while the blood is flowing, 
and the farther flow of blood prevented, if the breathing be properly relieved, be- 
fore faintness is induced. It is safer to trust the farther treatment of the case to 
leeches, which are, indeed, often necessary even when the jugular vein has been 
opened, and the loss of blood carried for the time to the greatest extent. This 
will not be matter of surprise, when we consider how little connexion there is 
between the arteries ramified upon the inner surface of the windpipe, and the ex- 
ternal jugular vein. It is safest, therefore, to unload the general circulation, where 
that is requisite, from the system at large ; and treat the local complaints with 
leeches, where they can be easily obtained : but if not, the finger may be placed 
upon the orifice for a short time, when the breathing is relieved; and another and 
a smaller quantity of blood be taken from the same orifice, until faintness deter 
us from proceeding farther. 

"I have generally directed leeches to be put on the lower part of the windpipe, 
below the pomum Adami, because they bleed quite as well as on the upper part 
of the tube. The blood is drawn from those vessels which have most recently 
taken on the diseased action; the inflammation is thereby prevented from extend- 
ing, and the vessels, already weakened by disease, are emptied more gradually, 
and with less danger of their giving way. 

"In whatever manner the blood be taken, a degree of faintness must be pro- 
duced, and kept tip for some time, which renders the continuance of inflammation 
impossible, and the patient watched most narrowly, lest reaction come on, and 
more leeches be necessary." 

We have made this long extract to show fairly this gentleman's pathological 
and therapeutical views of this disease; not, however, with the intention of re- 
commending the practice, for we still maintain our views unimpaired as to the 
mode of treatment— for in our hands, at least, leeching has been decidedly hurtful. 
If faintness be desirable, we would very much prefer Dr. Chapman's plan— that 
is, abstracting blood from the arm until a disposition to syncope be perceived. 
Or, indeed, this gentleman's suggestion, (though not original with him,) of open- 
ing the jugular vein; but not at the moment he indicates — for it is then, we fear, 
too late, as the symptoms he details mark the stage of effusion ; or, at least, that 
stage of inflammation at which it is about to take place; a period, if our observa- 
tions be correct, that effusion is but hastened by bleeding. We could say much 
upon the whole of Mr. G.'s text quoted; but we did not see his observations until 
this chapter was almost in type. 



OF C ROUP. 411 

perienced practitioner against making the difficulty of breathing 
the only indication for more blood-letting: this should constitute 
but one of the considerations ; for, of itself, it is not always suf- 
ficient, especially in a rapid case, or in one in "which the first 
stage of the disease was altogether neglected, and the commence- 
ment of the second but feebly treated. 

1584. To make a second bleeding proper, there must be a 
continuation of the same symptoms, though, perhaps, with a less 
degree of force, which made us determine upon this operation 
in the first instance; that is, the pulse must be firm, the skin 
warm, the face flushed, and the oppression considerable. 

1585. If these conditions obtain, we should not hesitate a mo- 
ment to draw more blood; and that to an extent that shall pro- 
duce an evident alteration in the force of the pulse: but two 
bleedings are not to follow each other, without the interval be- 
ing employed in the exhibition of other remedies ; and among 
the first of these are the emetics and the expectorants, as has 
been already advised, (1572 and 1578) together with the use of 
calomel. In this state of the disease, as in the one just consi- 
dered, the emetic should be followed by the hive syrup, so as to 
maintain a nauseating influence, as well as occasionally to provoke 
the stomach to vomiting. 

1586. The rubefacient remedies should now succeed the opera- 
tion of the emetic; and such a quantity of calomel should be 
administered, either with the tartrite of antimony, or alone, as 
already suggested, (1578,) as to procure a free discharge from 
the bowels. 

1587. The greater the disposition the disease has to run a ra- 
pid course, or, in other words, the more sudden and violent the 
attack, the greater, as a general rule, will be the chance of suc- 
cess from the use of proper remedies, and especially that of 
blood-letting; for it almost always happens that the slower cases 
are attended by an indolent inflammation, or an engorgement, 
that will not so well bear the loss of blood, or will certainly pro- 
fit less by it. 

1588. When the practitioner may be reluctant to draw more 
blood from the general system, and yet believes the inflammation 
cannot be subdued without further depletion, he generally has 
recourse to local bleeding — hence the frequency of leeching and 
cupping in croup. 

1589. This practice is recommended by almost every practi- 
tioner, and by some of very high authority: it may, therefore, 
not only excite surprise, but, perhaps, draw upon us reprehension, 
when we enter our protest against it ; and especially against 
leeching. (See note to par. 1582.) 

1590. We are free to admit it appears every way plausible 
that drawing blood from near the inflamed part should be attend- 



412 OF CROUP. 

ed with more success than when it is taken from a part more 
remote; yet, in the particular instance we are considering, our 
experience gives a uniform contradiction to the hope of benefit 
from the practice, though it does not impair the truth of the 
general position. But this failure of benefit from local bleeding 
in the case under consideration must not be considered, however, 
even as an exception to the general rule just mentioned, but as 
depending in a great measure, or, perhaps, altogether, on cir- 
cumstances inseparable from the operation of leeching itself. 
The operation of leeching is attended with several circumstances 
decidedly averse to this disease ; for, 1. It employs considerable 
time, during which the patient is obliged to maintain an irksome 
position, and this may be extremely unfavourable to his breath- 
ing. 2. It often becomes important that the quantity of blood 
to be drawn should be very exactly determined; this cannot be 
done in leeching — especially as the after bleeding is sometimes 
very considerable, in spite of every attempt to arrest it, to the 
manifest injury of the patient. 3. Their coldness, and the sud- 
den exposure of the throat, after having been warmly covered, 
is oftentimes so mischievous that the bad symptoms can be seen 
to increase during the operation, and are almost sure to follow 
immediately after. We can most safely declare we never have 
in a single instance seen it do good, but we have, in a number 
of cases, seen it do harm. 

1591. If topical bleeding be had recourse to, let it be by 
cups: against these the objections are not so strong. And, 
when employed, let it be from between the shoulders, or rather 
from the back of the neck: when drawn from this place, we 
have seen it useful. Cups should never be applied over the throat, 
for reasons sufficiently obvious. 

1592. Dr. Cheyne says, "When bleeding is used upon the 
commencement of the violent symptoms, the relief is often im- 
mediate ; and I have scarcely believed that I saw the same child 
breathing softly, who, ten minutes before, lay gasping and con- 
vulsed," (p. 17.) We have never had the good fortune to see 
this sudden good effect from bleeding in a case of genuine croup ; 
we have a number of times witnessed very prompt relief from 
this remedy, in the spurious, or that kind which is accompanied 
with sore throat, (1548.) For the vessels of the fauces seem to 
feel the influence of venesection more certainly and speedily than 
those of the mucous membrane of the trachea. 

1593. Neither in the stage of the disease now under considera- 
tion, nor in either of the other two, have we ever witnessed any 
advantage from severe purging, though there is evident use in 
having the bowels freely opened. Indeed, in the congestive 
stage, we think we have constantly found it injurious ; for it ra- 
pidly diminishes the strength, without weakening the disease at 



OF CROUP. 413 

the same time. For it would seem there is less intercommunion 
between the bowels and the respiratory viscera, than withjal- 
most any other parts of the body. 

1594. Puking in this stage, (the second,) is manifestly useful, 
especially when considerable nausea accompanies the operation: 
it must, therefore, be repeated as often as the breathing seems 
to be obstructed by accumulating phlegm. We believe the tar- 
trite of antimony to be the best emetic in this stage of the dis- 
ease. The sulphate of copper has been highly extolled lately ; 
in our hands it has failed. 

1595. Blisters are highly recommended by some: as regards 
our own experience, we are by no means convinced of their 
utility, unless it may be in the forming state of this complaint, 
and at the termination of the second ; but even then we are not 
in the habit of relying on them. We prefer the rubefacients, 
(1572) as their powers are more at command, and can be renewed 
whenever they have ceased to maintain a proper degree of irrita- 
tion. It has appeared to us there is a period of the disease in 
which blisters may be useful, but are not exclusively to be relied 
on, as just stated: we have occasionally employed them at this 
time, and once or twice with marked advantage. It is when the 
second stage is merging into the third. At this time, in some 
few instances, they seem to act with peculiar felicity. 

1596. "The warm bath is a very equivocal remedy; but as 
it is a simple and popular one, it is generally used along with an 
emetic, before the physician is called; and, together or sepa- 
rately, by their antiphlogistic powers, they in very many instances 
prevent the formation of the disease." (Cheyne, p. 25.) 

1597. There are few remedies in this disease so popular, or so 
much abused, as the warm bath — it is one we feel more difficul- 
ty in prescribing than any other of the materia medica, for it 
seems to us to be more uncertain, and varied in its effects, than 
any other. Nor is this to be wondered at, since the tempera- 
ture is never exactly fixed, and each given temperature must be 
a new remedy ; or, at least, a remedy with a different power. 
Again; the state of the nervous and arterial systems must be 
constantly varying; therefore, the effects of this remedy must 
necessarily be governed in a degree by these conditions. The 
state of the cutaneous system must also vary as to susceptibility ; 
therefore, temperature must have different operations upon it : 
these differences must, of course, lead to very different results; 
and this we have so uniformly found to be the case, that we 
never prescribe this remedy but with all the uncertainty which 
must necessarily attend applications empirically made. 

1598. Nor can we agree with Dr. Cheyne, in calling the warm 
bath a "simple remedy," if he mean that it is one without any 
decided powers; we look upon it as one of extensive influence; 



414 OF CROUP. 

and may, therefore, be most easily abused, if not judiciously di- 
rected, as it has, unfortunately, become a domestic remedy. Be- 
sides, let us call to mind the importance of the surface on which 
this remedy is to act, either as regards its own functions, or the 
functions of parts which so powerfully sympathize with it; and 
we shall find there is no good ground to consider this remedy as 
a " simple" one; at least, not agreeably to our definition of a 
simple remedy. 

1599. This, of all the remedies employed in croap, requires 
the most judgment in prescribing it, and certainly the greatest 
caution, to apply it property. We have never seen it managed 
with so much address as not to have made us tremble for the 
consequences, nor with so much success, as to tempt us to brave 
them. We can most conscientiously declare we have never in a 
single instance witnessed any decided advantage to arise from 
its application; but we can most truly say we have had the most 
unequivocal evidence of injury. We, therefore, never prescribe 
it in this disease. In this we are aware that we differ from 
much authority, and especially Guibert, who has written upon 
croup with much good sense and practical acumen: of the warm 
bath he is even extravagant (as we think) in its praise. He 
says, "A very rational means of the cure of croup consists in 
frequent and reiterated employment of warm baths, of which 
experience has taught me the good effects." But until subse- 
quent experience shall lead us to a contrary belief, we shall con- 
tinue -to bear testimony against it. We shall take the liberty of 
subjoining Mr. Goodlad's observations upon this remedy, as they 
serve to strengthen what we have just advanced. "Among these," 
he adds, " the warm bath is one of the most active and at the same 
time the most injurious; and I cannot imagine how any one, 
who has once witnessed its effects, can again recommend it in 
croup. It is, in my opinion, so decidedly hurtful, by quickening 
the circulation, that I should interdict its use in almost all in- 
flammatory cases. The warm bath, I think, is never useful, un- 
less prolonged until faintness be produced; and in the early 
stages of inflammatory complaints, it is often impossible to pro- 
duce this effect, until the heart beats more than 130 times in a 
minute, which is a degree of excitement I think unwarrantable. 
If resorted to later, effusion is brought on sooner than it would 
otherwise supervene; and many practitioners could, I think, 
call to mind cases where its use has been followed by unexpected 
death; the vessels previously emptied, perhaps, by bleeding, 
having given way, and apoplexy supervened." 

1600. Do not let us be understood to condemn this remedy, 
when employed by others, because we do not ourselves under- 
stand its management; we only mean to confess our ignorance 
of the proper state, or time, for its application. We are afraid 



OF CRO UP. 415 

that this remedy has become too much a part of routine in this 
complaint; therefore, very likely to be abused. There is a popu- 
lar feeling in its favour, which we are very certain it does not 
deserve; and in consequence, it becomes "a domestic remedy," 
and "is employed before the physician sees the patient," and 
that, we fear, to the injury of the individual who is subjected 
to it. 

1601. Laudanum, in combination with antimony, is recom- 
mended by Dr. Cheyne, when the febrile symptoms run high — 
we admit this to be high authority for the practice; but unless 
we witness more success from this combination in the hands of 
others, than has been experienced by ourselves, we shall not 
again be tempted to employ it. Laudanum, as far as our expe- 
rience goes, has ever been injurious in this stage. 

1602. If the disease do not yield pretty early after the for- 
mation of the second stage, to the remedies just pointed out, 
the vessels of the inflamed surface relieve themselves by effusion, 
and thus form 

The Third Stage. 

1603. This stage consists in the formation of a deciduous 
membrane, (1587, &c.) which more or less strictly fills the tra- 
chea, or else, in the pouring out of a quantity of purulent 
lymph, which does not coagulate; but almost as certainly ob- 
structs the air passages. This effusion is not confined, however, 
in all instances, to the trachea; the bronchial vessels relieve 
themselves in the same manner; and this, sometimes, through- 
out the lungs, as far, at least, as the naked eye can trace them. 

1604. It is of much importance to recollect this highly im- 
portant pathological truth; since it will have a strong bearing 
on the question of an operation, whenever this may be agitated. 

1605. The third stage (1557) is necessarily one of great hope- 
lessness ; since we cannot, with certainty, get rid of the exist- 
ing obstruction ; or, if we could, we cannot alter, or, at least, but 
very rarely, the disposition of the parts to perpetuate the dif- 
ficulty by the formation of new productions. 

1606. The indications in this stage are, 1st, to remove the ob- 
structing lymph from the windpipe ; and, 2dly, to prevent the 
formation of more by altering the condition of the inflamed sur- 
face of the trachea. 

1607. In some few instances emetics have fulfilled both the 
one and the other indications ; and the patient has been thus 
most unexpectedly snatched from the grave. 1 The membrane 

1 "I shall here notice those (remedies) only, which have been found decidedly 
beneficial. Of this kind are emetics, repeated daily, or even twice a day. They 
evidently accelerate the separation of the adventitious membrane, and favour its 
expulsion. However valuable this treatment maybe, and I have myself obtained 
cures which I could attribute to it alone, it is no doubt too true that the greater 
number of cases still prove fatal." — Laennec, p. 126. 



416 OF CROUP. 

has been more frequently removed from the trachea, than its re- 
moval has been attended by success to the patient, after its dis- 
charge. 

This is a most melancholy truth, and one that should not be 
lost sight of; especially as, on the removal of the membrane, re- 
covery is so confidently expected. Never shall we forget our 
feelings when this took place in a beloved child of our own ; nor 
ever cease to remember our disappointment, when we found it to 
be unavailing. 

At what period of the disease this membrane forms is very 
uncertain, — whether in a few hours, or not until several days. — 
A fine boy of two and a half years old, was very suddenly at- 
tacked with croup. His father very promptly applied the reme- 
dies for it — when it had continued for about two hours, he had 
almost strangled, but was suddenly relieved. Upon examining 
what he had thrown up, the membrane usually formed in this 
complaint was found, even to the bifurcation of the Asperia Ar- 
teria. It was in part preserved, and shown to Dr. Horner, who 
pronounced it a genuine membrane. He afterwards discharged 
a considerable quantity of plastic lymph. The child got well. 

1608. Michaelis, (Cheyne, case x. p. 65,) relates a case of 
death after the membrane was twice discharged by emetics; nor 
is this surprising, since, by the removal of the obstruction, we do 
not remove the disposition to subsequent effusion; and, as long 
as this continues, there can be no security against new forma- 
tions. 

1609. But this should not make us abandon an enterprise in 
which so much may be gained, if we succeed in removing the ob- 
structing membrane; especially as the same author furnishes us 
with an instance of success, after the membrane had been thrown 

1610. As in the third stage the obstruction is purely mecha- 
nical, so far as we know, and as that consists of a membranous pro- 
duction, but feebly attached to the side of the trachea, (1562,) 
as fresh lymph is, most probably, constantly pouring out, to 
weaken its adhesion, it would seem that that remedy which would 
give the most sudden shock to the respiratory organs, would give 
the fairest chance to remove it — hence the utility of pretty 
powerful emetics at this period. 

1611. In this all practitioners seem to agree ; but there is some 
variety of opinion on the proper substance for this purpose. In 
Europe, saline, or antimonial emetics are considered best; in 
this country the polygala seneca in very strong decoction is pre- 
ferred, and, we believe, with propriety. At least, the only in- 
stance we have witnessed of the expulsion of the membrane, was 
produced by a very strong decoction of this root. 1 We would, 

1 Take half an ounce of powdered seneca, pour on it half a pint of boiling water 
and let it simmer until nearly half reduced; strain it carefully, and give a tea- 



OF CROUP. 417 

therefore, rely on it with more confidence than any other of the 
emetic substances. 

1612. This medicine is, however, apt to run off by the bowels 
when exhibited thus strong: should this be the case, a quantity 
of laudanum, sufficient merely to restrain its purgative effects, 
should be given from time to time. Two or three drops every 
two or three hours, will generally be found sufficient for this pur- 
pose. 

1613. "VYe have but very little confidence in any other reme- 
dies in this stage of the disease; especially any that can fulfil 
the second indication, unless emetics do. The sulphate of copper 
has been much praised in this disease, and is by some supposed 
to possess much advantage over the antimonial preparations ; but 
in this commendation our own experience will not justify a pre- 
ference; we have employed it several times, and under circum- 
stances we deemed fair for its use, but without any advantage 
that we have not seen produced by the tartrite of antimony. 
We have never seen calomel, blisters, or warm bath, do the least 
good at this period; indeed, the painful remedies should now, 
we think, be withheld, (if we except the more powerful rubefa- 
cients,) since they hold out so little promise of success. We 
thought we saw evident relief in a late case, from the spirit of 
turpentine. 1 Twenty drops were given every hour; it seemed 
to relieve much, but the patient died. 

1614. As a last resource, tracheotomy has been proposed with 
confidence; but it has been but too often performed without suc- 
cess. Nor is this to surprise us ; since by the operation nothing 
more can be expected than has resulted from the spontaneous 
discharge of the membrane ; and we have already said, (1607) 
that this is but rarely followed by permanent relief. 

1615. In our opinion, the operation has been proposed with 
more intrepidity than discretion ; for until we can prevent new 
accumulations after the removal of the previous ones, we need 
promise ourselves but little success from this scheme. It has 
been said that the failure from this operation has been princi- 
pally owing to its being performed too late, and hence it has 
been advised early in the disease. But who would promise him- 
self that he had saved life by this operation, should the patient 
even live, since, if it be performed early, other remedies might 
have succeeded as well ? And when performed late, who has 

spoonful every fifteen or twenty minutes, until it puke. This quantity will answer 
for a child from one to three years old — for one of greater age, two teaspoonsful 
at a time may be given; but we believe the decoction should never be weaker 
than the above. 

1 What might be the effects of this medicine, if boldly pushed, in the congestive 
stage of croup, we have yet to learn : we think, however, it deserves a trial, as 
its influence upon the mucous membrane seems to be undisputed. We shall cer- 
tainly urge it on the first fair opportunity we have the misfortune to contend with. 

27 



418 OF WORMS. 

-witnessed its success ? Therefore, in the early stage of the dis- 
ease, the operation is certainly not called for, nor would it be 
proper to have recourse to it, since the disease is very often re- 
lieved without it, and, in the latter, we believe it has ever been 
unavailing. 

1616. We have seen it performed twice without success, where 
the operation, simply considered, had every advantage which 
sound judgment and consummate skill could give it — for Dr. Phy- 
sick was the operator. And we believe we do not venture too 
much when we say he has no confidence in it. Dr. Gheyne em- 
ploys some most convincing arguments against this operation ; 
to which we with much pleasure refer those who may wish to 
investigate this subject farther. 

1617. But notwithstanding the unmanageable character of 
this disease, when its first stages have been neglected, or feebly 
treated, we have the experience of some of the most respectable 
practitioners as well as our own, that, when early attacked by 
proper means, there are few diseases of equal violence so en- 
tirely under the control of medicine. 



CHAPTER XXXIII. 

OF WORMS. 

1618. There are few parts of the human, or even of the brute 
body, which may not be infested with worms, if any reliance can 
be placed upon the observations of philosophers and physicians. 
But our present purpose is only with such as infest the stomach 
and bowels of children. 

1619. It would seem to be agreeable to all observation, that 
children are seldom without more or less of these animals; in- 
deed, so common are they in the human bowels, that Dr. Butter 
has attempted to sustain a most extraordinary thesis upon the 
subject. He declares them to be "nature's remedy for destroy- 
ing the superabounding morbid humours; and to stimulate the 
first passages, by their crawling motions, and thereby assisting 
the peristaltic motion of the guts to carry off what remains of 
the offensive load." 

1620. As a general rule, we believe it entitled to confidence, 
that children altogether confined to their mother's milk, never 
have worms. That is, to be sure, contradicted by M. de Lille, 
who affirms that worms were expelled from his daughter, who 
was only eleven months old, and who was altogether confined to 
the breast. As regards our own testimony, we declare we have 



OF WORMS. 419 

never seen worms in children under ten months old ; and only 
two instances of that age: both of these children were weaned 
at four months. 

1621. From this, it would seem there is a protection against 
these animals in the mother's milk, so long as the child is ex- 
clusively confined to it; but the moment it leaves it, it becomes 
obnoxious to them. It is pretty evident, then, that these ani- 
mals are introduced into the stomach and bowels from without, 
by means of the various articles of food upon which the child 
lives. 

1622. Hence, children who live much upon crude aliment are 
more obnoxious to worms than those who are provided with a 
constant supply of wholesome and nutritious articles of diet. 
And, also, that those whose powers of digestion are strong, are 
seldom troubled with these vermin. In feeble or dyspeptic sto- 
machs, these animals are not only much more common, but also, 
much more mischievous; since, from the imperfect condition of 
the gastric powers, the secretions permit them to remain unin- 
jured by its influence; and, also, that in feeble constitutions, 
the secretions from the bowels themselves are never so freely or 
entirely thrown off, as in robust frames; and being retained, offer 
a nidus at least for the engendering of these vermin ; therefore, 
the best security against these animals is a healthy condition of 
the stomach and bowels, and a nutritious and invigorating diet. 

1623. Children who have access to crude unripe fruits, and 
who do not restrain their appetites from indulging in them, are 
particularly liable to suffer from worms ; and this for two rea- 
sons; 1st, because the ova of many are introduced by the food 
itself; 1 and, 2dly, because the weakened powers of the stomach 
permit them to be hatched, from the want of force in the gastric 
liquor; for we have every reason to believe that few animals can 
resist its influence when in a state of perfect health. 

1624. And upon the same principle it can be readily under- 
stood how they can multiply and thrive, after they once have 
possession of the stomach and bowels ; especially as it is well 
known they reside in the mucous secretion of these parts ; and how 
to the parts themselves they may become irritants, and force 
them to a more abundant secretion ; and hence, from a profuse 

1 We are aware that the idea of the ova of worms being introduced into the sto- 
mach by fruit, and hatched there, is not believed by some, and even ridiculed by 
others, because, say they, there is no similarity between the worms expelled from 
the body, and the worms found in unripe or injured fruit— but this is taking but 
a limited view of the subject; since it is certain that very considerable varieties 
have been observed to pass per anum, and may, doubtless, have escaped unnoticed. 
Besides, the difference in nourishment, and even, perhaps, a change of habits, may 
alter the form of these animals : the leech, it would seem, undergoes a great 
change when introduced into the bowels and permitted to revel there, as we shall 
notice below. 



420 OF WORMS. 

supply of rich nourishment, they seem to thrive almost beyond 
their natures, and can scarcely be recognised as specimens of 
the class to which they belong. 

1625. Almost every writer on the practice of physic mentions 
extraordinary examples of the kind; and both foreign and do- 
mestic journals furnish like instances. And it would seem to be 
a matter placed now beyond dispute, that many aquatic animals 
may gain possession of the stomach, either in the form of ova, 
or in a viviparous state. Thus, the horse-hair worm, though an 
aquatic animal, is frequently found in the stomachs of the pea- 
santry of Lapland, and introduced there, agreeably to Linnaeus, 
by drinking of the half putrid water of their ponds. 

1626. After the same manner, the leech has been conveyed 
into the stomach when minute and young, along with the muddy 
and stagnant water they are known to inhabit. Of this kind is 
the remarkable case related by Mr. Paisley, in Vol. II. Art. 
xxvi. of the Ed. Med. Essays. And also of an analogous kind 
is that related by the late Dr. Bond, of this city, in the Lond. 
Med. Observ. and Inq. Vol. I. p. 68. In the first of these in- 
stances, a gentleman voided two animals of the leech kind, each 
measuring a foot and a half in length, and an inch and a half 
in diameter. In the second, a worm of twenty inches in length 
was voided by a woman, after great suffering, and of which she 
died. On opening the body, it was found that the animal had 
worked its way into the liver through the common duct, and com- 
mitted great havoc on that organ ; after which it seemed to have 
travelled back, and had forced its way again, with much difficul- 
ty, through the same duct, into the intestines, whence it was dis- 
charged dead and in two portions. 

1627. It is in vain to urge that these animals cannot be in- 
troduced from without into the human system, as the aliment and 
mode of life must not only be different, but their habits must 
also be destroyed, in a place of such confinement — the facts 
speak for themselves. 

1628. It is true the cases just mentioned are exceptions to the 
general inhabitants of the stomach and intestines ; yet, perhaps, 
there is nothing more marvellous in the one instance than in the 
other; since we cannot admit, with our present data, that there 
are varieties of worms proper to the human stomach and bowels. 
If they are extraneous, as we believe them to be, it only follows 
that the kind usually found are much greater in number; more 
easily introduced, or of more hardy habits; resisting and over- 
coming the disadvantages of their new situation, and eventually 
thriving and revelling in the plenty of their adopted habitation. 

1629. The worms commonly found in the human body are di- 
vided into the " round," and the "flat." These are arranged ac- 
cording to the disease or symptoms to which they give rise : 1st, 



OF WORMS. 421 

those which can be nourished in any portion of the alimentary 
canal; 2dly, those which locate themselves at the lower extre- 
mity of the canal ; 3dly, those which have no " local habitation," 
and seem to have wandered there erroneously: hence they are 
divided into three species, and called, 

1. Alvine worms, or Helminthia Alva. 

2. Anal worms, or Helminthia Podicis. 

3. Erratic worms, or Helminthia Erratica. 

Species I. Of Alvine Worms. 

1630. "Worms existing and finding a proper nidus in the 
stomach or alvine canal, chiefly of children, and sickly adults ; 
producing emaciation, a swelled, hard belly, gnawing or pungent 
pain in the stomach, pale countenance, fetid breath, and irrita- 
tion of the nostrils." (Good, Vol. I. p. 200.) 

1631. The worms which give rise to the above symptoms and 
inhabit the regions designated, are arranged under the following 
varieties : — 

A — Long round worm, or Ascaris Lumbricoides. 1 
B — Long thread worm, or Tricocephalus. 2 
C — Long tape w T orm, or Taenia Solium. 3 
D — Broad tape worm, or Taenia vulgaris. 4 

1 "The head of the long round worm is slightly incurvated, with a transverse 
contraction beneath it; mouth triangular; body transparent; light yellow, with 
a faint line down the side; gregarious and vivacious; from six to fifteen inches 
long; inhabits principally the ileum, but sometimes ascends into the stomach, and 
creeps out of the mouth and nostrils; occasionally travels to the rectum, and 
passes away at the anus." (Good, Vol. I. p. 200.) 

* "The body of the long thread worm is, above, slightly crenate; beneath, 
smooth, finely striated on the fore part; the head obtuse, and furnished with a 
slender retractile proboscis; tail, or thinner part, twice as long as the thicker, 
terminating in a fine hair-like point, about two inches long: in colour resembles 
the preceding; gregarious, and found chiefly in the intestines of sickly children; 
generally in the caecum." (Ibid. p. 201.) 

' "In the long tape worm the articulations are long and narrow, with marginal 
pores, by which it attaches itself to the intestines, one on each joint, generally 
alternate; ovaries arborescent; head with a terminal mouth, surrounded with two 
rows of radiate hooks, or holders; and a little below, on the flattened surface, 
four tuberculate orifices or suckers, two on each side; from thirty to forty feet 
long, and has been found sixty. Inhabits the intestines of mankind, generally at 
the upper part, where it feeds on the chyle and juices already animalized. Is 
sometimes solitary, but commonly in considerable numbers; and adheres so firmly 
to the intestines that it is removed with great difficulty. It is said to have the 
power of reproducing parts which have been broken oft; but this assertion wants 
proof. The animal is oviparous, and discharges its numerous eggs from the 
apertures on the joints. The broken off joints have, when discharged, the ap- 
pearance of gourd seeds ; and it is hence denominated gourd worm by many 
medical writers; and is the lubricus cucurbitimis of Dr. Heberden." (Ibid, 
p. 201.) 

* " The articulations of the broad tape worm are short and broad, with a pore 
in the centre of each joint, and stellate ovaries round them; body broader in the 
middle, and tapering towards both ends; head resembling the last; inhabits the 
upper part of the intestines, and feeds on the chyle; from three to fifteen feet long; 
usually in families of three or four." (Ibid, p. 202.) 



422 OF WORMS. 

E — Fluke, or Fasciola. 1 

1632. As it is not necessary to our purpose, we have not given 
a long technical description of each of these varieties; nor shall 
we of the succeeding ones. We have mentioned them because 
they are more or less frequently met with in practice. It may, 
however, be well to observe that the first of these is found much 
more constantly than either of the other varieties — we would 
not, however, pretend to say in what proportion. 

Species II. Anal Worms, or Helminthia Podicis. 

1633. "Worms, or the larves of insects, existing and finding 
a proper nidus within the verge of the anus, exciting a trouble- 
some local irritation, sometimes accompanied by tumour, fre- 
quently preventing sleep, and producing pain or faintness in the 
stomach." (Good, Vol. I. p. 203.) 

1634. Under this species are included the following varieties: 

A — Thread worm, 1 A . ^ T . , . 2 

M w ' > or Ascaris Vermiculans. 

aw Worm J 

B — Beetle grubs, or Scarabseus. 3 

C — Bots, or (Estrus. 4 

Species III. Erratic Worms, or Helminthia Erratica. 

1635. "Worms, or the larves of insects, introduced by acci- 
dent, and without finding a proper habitation in the stomach or 
intestines; producing spasmodic colic, with severe gripings ; and, 
occasionally, vomiting, or dejection of blood." (Good, Vol. I., 
p. 205.) 

1636. Of these worms, according to Dr. Good, but little is 
known, though there is good authority for introducing them — 
and we have been the more readily induced to follow him in this 
particular, as we met with two distinct species, as we are dis- 
posed to believe, in the same child, within a few days, and alto- 
gether different from any we have hitherto seen. 

1 " The body of the fluke is flattish, with an aperture or pore at the head, and 
generally another beneath; intestines flexuous: ovaries lateral ; hermaphrodite, 
and oviparous." (Good, Vol. I. p. 202.) 

3 "The head of the thread worm is subulate, nodose, and divided into three 
vesicles, in the middle of which it receives nourishment; skin at the sides of the 
body finely crenate or wrinkled, tail finely tapering, and terminating in a point; 
gregarious; viviparous; about half an inch long; sometimes wanders into the in- 
testines, and occasionally as high as the stomach." (Ibid. p. 203.) 

3 "This variety has not been accurately described;" "the following seems to 
be the chief: gray larve, with yellowish legs, and ferruginous head;" "have six 
feet; are annulate, hairy, vesicular at the end of the abdomen, and furnished with 
a horny head." (Ibid. p. 204.) 

* " The larves of the oestrus, breeze, or gad-fly, are called bots, and are of a 
round figure; pale green; tail obtusely truncated; head tapering, mouth horny, 
with two lips, and two recurved black claws on each side of the mouth." (Ibid, 
p. 204.) 



OF WORMS. 423 

Of the Treatment. 

1637. We are but imperfectly instructed upon this point, and, 
perhaps, will remain so, until practitioners shall be better able 
to ascertain the effect of remedies on each individual species of 
these animals, and shall learn to distinguish them by the symp- 
toms they give rise to. The whole of the symptoms which these 
vermin create are familiarly said to be produced by "worms;" 
and, it is probable, they do not yield the same variety in effect as 
their diversity of species would lead us to suppose. Nor is this, 
perhaps, much to be wondered at, since the whole train of symp- 
toms to which they give rise is produced by an irritation imposed 
on some one portion of the alimentary canal or stomach; and it 
would require greater power of discrimination than is generally 
possessed, to detect the cause or the particular nature of the ir- 
ritant. So general, and so uniform, for the most part, are the 
symptoms arising from almost any irritation of the bowels, that 
one cause may readily be mistaken for another: thus, we have 
frequently seen all the symptoms usually attendant upon worms 
completely simulated by the presence of acrid bile; and the 
reverse. Therefore, so far are we from being able to detect the 
species of worms, that we cannot say with perfect confidence 
that the symptoms are the result of even the genus; since, as 
we have just observed, other irritants may produce similar phe- 
nomena. 

1638. Yet it is but reasonable to conjecture that each species 
may have its antipathies and even its poisons; and this would 
seem to be strengthened by what is observed with some other of 
the inferior animals, in the selection and rejection of certain 
articles which may in their turn be food or poison, as it may be 
one species, or another, that employs them. Thus, the deer 
eats with impunity the deadly laurel, while the sheep is instantly 
destroyed by it, &c. 

1639. May not this diversity in what shall consist a whole- 
some nutriment, or in what may constitute a poison, help us to 
account for the extravagant encomiums bestowed by some upon 
an article, as anthelmintic; and the disparaging accounts of the 
same article, for the same purpose, by others? Is it not pro- 
bable that the success of the article, when it proved useful, de- 
pended upon its being obnoxious to one species of worms ; and 
its want of success, to its not proving so to others? Is this not 
rendered still more likely from the fact, that that which shall 
detach and expel from the bowels lumbrici, shall not stir the 
taenia solium. 

1640. We believe this to be more than conjecture — and it 
would be well for practitioners to record, with each successful 
treatment of worms, the particular species, nay, if possible, the 



424 OF WORMS. 

variety of this animal ; the precise nature of the agent employed, 
and the particular situation of the patient at the moment; to 
record any auxiliary remedies, if such there were ; and to note 
down any and every circumstance, that in his opinion may have 
given efficacy to the plan which had been adopted. 

1641. We have observed, (1637,) that the presence of any 
species or variety of worm, gives the same kind of disturbance 
to the system; and that at the present moment we cannot detect, 
by any peculiarity of symptoms, by what species the mischief is 
created. Dr. Heberden has laid down the marks by which worms 
may be suspected, (for it amounts to nothing more) in the fol- 
lowing order: — 

1642. "The evils which hence arise, and which cease upon 
their expulsion, are headaches, vertigo, torpor, disturbed dreams, 
sleep broken off by fright and screaming, convulsions, feverish- 
ness, thirst, pallid hue, bad taste in the mouth, offensive breath, 
cough, difficult breathing, itching of the nostrils, pain in the 
stomach, nausea, squeamishness, voracity, leanness, tenesmus, 
itching at the anus towards night; at length, dejection of films 
and mucus. The broad tape worms produce the severest mis- 
chief on the body; while the terrestes and ascarides, (round and 
thread worms,) sometimes lurk, scarcely suspected, unless there 
be an itching of the anus, or they are traced in the faeces." 

1643. Yet, what practitioner with all this long list of formi- 
dable symptoms combining in one person, would risk his reputa- 
tion upon the event, that they were produced by worms ? It 
must be familiar to every body exercising the profession of me- 
dicine, to meet with cases in which so many of the enumerated 
signs have combined, as to leave no doubt of the existence of 
worms ; yet the issue of the case has not always verified the con- 
jecture ; at least not by any direct evidence ; such as the expul- 
sion of these animals. While, on the other hand, he has seen 
them driven off in shoals, where a suspicion of the agency has 
scarcely been awakened. 

1644. Dr. Heberden has failed to mention a symptom which 
we believe was first noticed by Home ; and which, when it exists, 
for it is not always present, is less equivocal than any other we 
have met with : namely, an cedematous swelling of the upper lip 
and lower part of the nose. 

1645. Worms injure the body they inhabit in one of three 
ways : — 

1st. By irritation. 

2dly. By destroying the nourishment intended for the support 
of the child. 

3dly. By their bulk from accumulation. 



OF WORMS. 425 



1st. Irritation. 



1646. "When the stomach and bowels become irritated by the 
presence of worms, there is scarcely a part of the body which 
does not sympathize with it, and manifest its sympathy by some 
marked derangement of the part. Thus, the lungs have assumed 
the appearance of consumption, by cough, hemorrhage, &c. ; the 
uterus has been urged to flooding; the brain to mania, coma, 
delirium; the nose to bleeding; the trachea to croup, &c. &c, if 
any reliance can be placed upon the observations of authors. 

1647. The production of cough is familiar; that of simulated 
phthisis is more rare, yet met with. The uterus is but rarely, 
we believe, involved; not because it does not sympathize largely 
with many parts after puberty, but because the affections under 
consideration are more common to early life, and, consequently, 
before this organ has received such development as to render it 
a sympathizing part or source. The aberrations in the functions 
of the brain from this cause almost every body has witnessed. 
A very remarkable instance of this kind fell under our notice 
lately, which it may be interesting to relate. 

1648. The daughter of T. P. R., aged eleven, was suddenly 
attacked with fever and delirium. We were sent for immedi- 
ately, but being unwell a friend visited her for us. She was 
ordered to lose six ounces of blood, and to be freely purged by 
calomel, &c. The following morning the delirium was increased ; 
the fever equally high, though she had been liberally purged, and 
the blood had been drawn: the blood showed no marks of in- 
flammation. She was ordered to lose six ounces more of blood; 
to take small but repeated doses of calomel. In the evening, 
every symptom was aggravated, or, rather, she was perfectly 
comatose, from which it was difficult to rouse her even to take 
drink ; her tongue was very dark and dry, as far as could be 
ascertained by looking into the mouth, for she could not be 
roused sufficiently to make her put it out; the pulse small, wiry 
and frequent; the skin cold, but dry; no urine; the eyes half 
closed ; stools of a very dark brown colour, and extremely offen- 
sive, and passed involuntarily; in the last, while we were there, 
a lumbricus was found. 

1649. The case appeared'a forlorn one ; but we did not abandon 
all hope: blisters, sinapisms and wine whey, together with an 
infusion of pink root, (the spigelia Marilandica,) were ordered 
for the night. On our visit, the next morning, seventeen lum- 
brici were shown us, that had passed a little while before. The 
patient, in every respect, better; the coma much less; the skin 
warm, but not febrile ; the pulse more open, and less frequent; 
passed urine freely; had command of her evacuations. 

1650. The pink root tea ordered to be continued ; no other 
medicine ; wine whey to be withheld, and gum Arabic water sub- 



426 OF WORMS. 

stituted. On our visit in the evening, we found seven more 
worms had passed. The patient comparatively well — she rapidly 
recovered from this moment. 

1651. In this case it is evident the whole train of formidable 
symptoms was produced by some peculiar irritation in the 
bowels from the presence of worms: whether this irritation arose 
from the motion of these animals upon the denuded bowels by 
a destruction of their proper mucus ; or whether, from a deficient 
supply of nourishment, they inflicted any mechanical injury upon 
the bowels, may be difficult to say; but we think it every way 
probable, that their brisk motion against the internal surface of 
the intestines, producing great irritation, or more or less inflam- 
mation of the mucous coat of the latter, may account for the 
extreme derangement of the system; especially if they had sud- 
denly migrated from one part of the intestinal canal to another. 

1652. We have seen a number of instances where this change 
of abode has been made; and this, most probably, being sud- 
denly performed, created prodigious disturbance in the system ; 
and these cases are, perhaps, more frequent than is suspected. 
We can best illustrate this position by the relation of a case — 
M. M., aged between four and five years, was suddenly at- 
tacked by intense fever ; face extremely red ; skin burning hot ; 
great thirst, with considerable nausea ; great delirium ; pulse 
bounding; together with a strong propensity to bite everything 
presented to him, or even his bed clothes. The child was one 
naturally of great vivacity; and, for his age, used a great 
deal of exercise, and had never, until that moment, shown any 
signs of indisposition, with the exception of fever from inocu- 
lated small pox; (this was in 1790:) he had been, until al- 
most the moment of attack, as cheerful and playful as usual. — 
Living in the same house with him, and being at home, we were 
requested to see him, and we found him in the situation just de- 
scribed. 

1653. From the suddenness of the attack, and the ferocity of 
the symptoms, and especially as this was an indulged child, we 
judged that his indisposition could only arise from some impro- 
per article introduced into the stomach, either in the form of 
food, or drink — from this view of the disease, we prescribed ten 
grains of ipecacuanha, which was instantly administered ; and it 
was equally prompt in its effects ; the very first effort brought from 
the stomach one, and the succeeding discharge two more large 
lumbrici. These animals had hardly been ejected from the sto- 
mach, before the whole of the unpleasant symptoms vanished, to 
return no more until twelve months after, when there was a 
repetition of all those just enumerated. The same plan was pur- 
sued, and the same result followed. Another year produced a 
repetition in every respect like the former; and the same sud- 



OF WORMS. 427 

den cessation of symptoms followed the use of the emetic. Since 
the above period, we have seen several other cases, in every re- 
spect analogous to the one above described: these cases give 
evidence that the mere crawling of these animals over the sur- 
face of the stomach, may produce symptoms of the most violent 
kind, and render it extremely probable that the like may arise 
from a similar action on the tender surface of the intestines. 

2. By the Destruction of the proper Nourishment of the Child. 

1654. From the little we know of the habits of these animals ; 
by their being almost constantly found to inhabit or nestle in the 
mucous secretion of the bowels ; by their never, so far as we re- 
collect, being found attached to the coat of the intestines ; from 
the certain emaciation which is sure, sooner or later, to follow 
their presence, it is every way presumable that they feed in part, 
if not altogether, upon the chyle intended for the support of the 
system. Therefore, the injury to the child, on this supposition, 
will in general be in proportion to the number and size of these 
animals ; hence the extreme attenuation of the body, from a large 
number of lumbrici, and from the taenia solium. Nor is this to 
be wondered at, when the former may be very numerous, or the 
latter of almost incredible length. 

1655. They may also contribute to emaciation in an indirect 
manner: 1st, by stimulating the mucous membrane to excessive 
action, and oblige it to pour out an unusual quantity of fluid, 
either for their comfort as a nidus, or for their support as a 
nourishment; 2dly, by diminishing the appetite, and thus pre- 
venting the common quantity of food from being taken ; or, if 
there be appetite, it is generally of an inordinate kind; forcing 
the stomach to receive more than it can master, and consequently 
impair the powers of this organ ; so that it will neither digest as 
much as ordinary, nor properly elaborate that which it reduces 
to chyme. 

1656. It will be seen that it will only be the "alvine, or er- 
ratic" worms, which can produce great emaciation; the anal, 
though creating great inconvenience, rarely produce emaciation; 
since they do not appear to live upon any other than the stercal 
contents of the bowels, and, therefore, cannot occasion any great 
waste of the natural fluids. 

3. By their Bulk from Accumulation. 

1657. "Worms may do much injury by their bulk; for their 
numbers, as frequently happens with the ascarius lumbricoides, 
may become excessive. Of this we have seen numerous instances, 
and they must be familiar to every practitioner. One of the 
most remarkable cases of this kind which has fallen under our 



428 OF WORMS. 

own notice, we shall relate. A poor woman living at the falls 
of Schuylkill begged us, when near her house, to look at one of 
her children, which she represented as being almost in the last 
stage of human misery. 

1658. The child, whom we now visited, was about twenty 
months old ; it had had, during the whole of the summer, (our 
visit to it was in September,) a diarrhoea, for which every known, 
and almost every unknown remedy, had been tried in vain, as 
regarded the relief of the child, though they abated the bowel 
complaint. The child had cut most of its teeth, and was still at 
the breast. It gradually wasted in its limbs and back, but its 
belly seemed to increase in a direct ratio to the emaciation of 
the other parts; it was literally nothing but skin and bones, with 
the exception of the belly, which was enormously distended and 
semi-transparent. It lay on its back, apparently without power 
to move from its position. It appeared in great and constant 
agony. 

1659. Believing this to be a case of worms, we ordered half 
an ounce of pink root in infusion ; this to be given in small por- 
tions, as frequently as it would be received. On our visiting the 
child the next day, we were presented with a sight that was truly 
appalling; ninety-six worms were shown us in a vessel, the shortest 
of which measured six inches, and the longest ten. Forty-five 
of these came away in one mass; the remainder at several differ- 
ent efforts. The child required no other medicine ; nourishment 
soon restored its health. 1 

1660. Since worms may do injury in the several ways we have 
just pointed out, it becomes a matter of great consequence to ex- 
pel them as certainly and as quickly as possible. For this pur- 
pose, an immense number of substances have been tried; some 
of which, indeed we may say by far the greater proportion, have 
failed, though ranked under the head of anthelmintics by syste- 
matic writers. It would seem, from the long list of articles ex- 
hibited by authors, purporting to possess anthelmintic properties, 
that many of them must have acquired this distinction from the 
mere contingency of these animals being expelled after their ex- 
hibition, without their having any direct agency in their extru- 
sion; for upon subsequent trials they were not found to possess 
any such power; while, on the other hand, some few appear to 
be justly entitled to the reputation they have acquired among 
practitioners of almost every nation. Of this kind we may men- 
tion, the Carolina pink root, (Spigelia Marilandica,) the Jeru- 
salem oak, (Chenopodium anthelminticum,) the cabbage-tree 
bark, (Geoffroya inermis,) the cowage, (Dolichos pruriens,) the 

1 We are told that one hundred and eighty lumbrici, from six to ten inches each 
in length, were found in the jejunum and ilium of a child that died of scarlatina. 
—Med. Chir. Rev. Nov. 15, Decern. 1823. 



OF WORMS. 429 

oil of turpentine, the male fern, (Polypodium filix mas,) calomel, 
and a few others. 

1661. The whole of the anthelmintics may be classed under 
three general heads : 1st, those which seem to possess some speci- 
fic action upon the constitutions of worms, by a narcotic or other 
power; 2dly, those which would appear to act upon their bodies 
mechanically; 3dly, those which seem to prevent, either the de- 
velopment of their ova, in the oviparous kind, or act in an un- 
friendly manner upon the young of the viviparous, as soon as 
they are expelled from the matrices of the parents; or by mere- 
ly restoring to the bowels and stomach their lost tone. 

1662. Under the first division may be reckoned the pink root, 
the Jerusalem bark, the cabbage tree bark, the male fern, the 
oil of turpentine, and perhaps calomel. Under the second we 
may enumerate steel filings, tin filings, and the cowage. To the 
third belong all the invigorating bitters, as tansy, rue, wormwood, 
gentian, &c, the chalybeates, and the muriate of soda, or com- 
mon salt. 

1663. We have already observed, (1637) that we are not in 
possession of the diagnostics of worms even as a genus, much 
less the species, if we except the expulsion of them: we are, 
therefore, obliged to prescribe for these vermin pretty much at 
random, both as regards genus and species. In doing this, how- 
ever, no serious mischief can arise ; since, if the remedy be not 
exactly suited to the species, it only ends in a failure, without 
doing any mischief, unless the anthelmintic plan has been inju- 
diciously pursued, or too constantly persevered in. 

1664. When we have reason to suspect worms to be the cause 
of the symptoms for which we are desired to prescribe, it is re- 
commended by Dr. Good to commence the course by brisk pur- 
gative remedies, with a view to remove from the bowels a quan- 
tity of the mucus in which these animals are wont to burrow. 
We confess ourselves to have a high respect for the learning and 
talents of this gentleman, but at the same time we must declare 
it is a plan which has never succeeded in our hands; nay, it has 
for many years been our deliberate opinion that it even proves 
mischievous, by making these animals, if we may so express 
ourselves, cling more closely to the bowels, by some power or 
other, and thus disappoint the expectations of the practitioner. 
We, therefore, never prescribe a purgative, when about to assail 
these animals, but at once commence with the remedy we may 
select for trial, and persevere in it for a given time : when this 
direction has been complied with for a proper period, we then 
give a cathartic : this may be either calomel, castor oil, or an in- 
fusion of senna. 

1665. The most decidedly efficacious remedy, in our hands, 
for the long round worm, Ascaris lumbricoides, (1631) is the pink 



430 OF WORMS. 

root, in infusion; and. we can most safely declare it has rarely 
failed where it has been faithfully administered. This remedy 
has to contend against much prejudice ; it is declared that the 
most violent, nay, deadly symptoms have followed its use; as 
convulsions, paralysis, vertigo, loss of sight, permanent headache, 
&c. If such symptoms arise, (and there can be no doubt that 
they have,) they can only have proceeded from over doses of this 
medicine; 1 and if this be so, what medicine may not be charge- 
able with similar evils from similar management? 

1666. We have prescribed this remedy many hundred times, 
and we declare we have never, except in a single instance, wit- 
nessed any distressing symptoms to arise from it ; in this excep- 
tion, a slight squinting, with delirium, followed its exhibition : 
but even in this case, the evils were very evanescent, for they 
disappeared in the course of four or five hours. The mother of 
this child informed us that this plant had uniformly produced the 
same symptoms in all her children. We are, therefore, of opi- 
nion, that there is no good ground for rejecting this medicine, 
upon the score of deleterious narcotic properties, whenever it 
shall be given in proper doses, and at proper periods. 

1667. An objection of another kind, however, may with more 
success be urged against it; namely, its bulk. Some, with a 
view to diminish this, have given it in powder instead of infusion. 
We have repeatedly tried the medicine in this form, but find it 
does not lessen the difficulty. For a number of years past, we 
have succeeded entirely, by exhibiting it in coffee, to such chil- 
dren as may be in the habit of using this article of diet — but 
with such as do not, the difficulty still remains. Might not an 
extract be made, and still retain the valuable properties of the 
plant? 

1668. Our plan for its use is as follows : pour upon the proper 
quantity of the pink root from half a pint to three gills of boil- 
ing coffee, and permit it to stand, closely covered, until it be 
sufficiently cool to drink. One half of this must be poured off, 
sweetened, and have milk or cream added to it : when thus pre- 
pared, the child is to drink it at its breakfast as if it were coffee 
alone; it may take it with bread and butter, &c, as in ordi- 
nary. The other half is to be given in the evening in the same 
manner after warming it. This quantity is to be repeated for 
three days consecutively ; and on the fourth it must be followed 

'In almost every instance of which we could hear, with any certainty, of mis- 
chief following the use of the pink root, it was owing to over doses of this reme- 
dy — we, therefore, are very particular in prescribing the quantity to be given; for 
children from one year to two, we give but two drams ; for those from two to 
five, we order one-third of an ounce; from five to twelve, we give half an ounce: 
and, for adults, we never exceed six drams. We do not believe it safe to go be- 
yond these doses; and we are certain, from often repeated trials, that these quan- 
tities are sufficient, whenever this plant is the proper remedy. 



OF WORMS. 431 

by a pretty brisk cathartic of calomel and jalap, castor oil, or 
senna tea. We can say, with much confidence, that this plan 
rarely fails, unless the bowels are spontaneously opened, should 
there be worms of the kind just mentioned. 

1669. Should, however, no worms appear, and the symptoms 
for which the pink root was prescribed continue, we are in the 
habit of giving the worm seed oil, (ol. Chenopod.) in appropriate 
doses, provided there be no fever — should fever attend, this re- 
medy must not be thought of: in such case, small doses of calo- 
mel appear to ansAver best; therefore the pink root has a decided 
advantage over the chenopodium, since it may be exhibited with 
perfect safety even when fever is present. 

1670. With young children who are not in the habit of using 
coffee, the worm-seed oil is of more easy exhibition than the pink 
root, and, on this account, may merit a preference, where the 
condition of the system will permit its use. The seed of the 
chenopodium is in familiar use in many places ; and, it is said, 
with decided advantage — of this we cannot speak from our own 
experience. The seeds are reduced to powder, and made into 
an electuary with any syrup. Of this a child of two or three 
years old may take a table-spoonful morning and evening, ab- 
staining for several hours from food. These doses must be re- 
peated for several days, if necessary. The seeds are also given 
on bread and butter. 

1671. Of the cabbage-tree bark we can say nothing from ex- 
perience ; and of the cowage we can say nothing favourable, as 
it failed in each of the few instances in which we tried it, though 
the pink root succeeded afterwards. Of the other mechanical 
remedies we know nothing: the tin has been highly extolled, and 
may deserve a trial : but it would seem better calculated for the 
tape worm, for which it has been principally recommended. 

1672. For ascarides, (1634,) the aloetic medicines are cer- 
tainly the most useful. These worms produce more decided evi- 
dence of their presence, perhaps, than any other; since the 
troublesome itching at the anus rarely arises from any other 
cause; besides, they can often be detected in the folds of the 
rectum, by distending this part by pressing the nates from each 
other, so as to open the sphincter ani, as well as in the evacua- 
tions, especially after a costive stool. 

1673. The attempt to dislodge these troublesome intruders is 
not always as successful as could be wished, particularly when 
they are old inhabitants of the rectum. The plan we have 
hitherto found most certain consists in the exhibition of small 
and often repeated doses of aloes. The preparation we are in 
the habit of employing for this purpose is the elixir proprietatis, 
in doses suited to the age of the patient. 1 After this has been 

1 We give twenty drops of thi3 medicine, morning, noon, and evening, in a little 



432 OF WORAfS. 

given for some time, enemata of lime-water, 1 camphor, 2 or aloes, 3 
should be had recourse to, which often destroys them altogether. 
When the itching is very troublesome, the lime-water injections 
relieve very decidedly, as does also a little tar-ointment, forced 
within the sphincter ani. 

1674. We have no certain marks to distinguish taenia (1631) 
from other worms. From its immense length and peculiar 
habits, emaciation takes place more rapidly and extensively than 
in the other genera and species of worms. A gnawing sensa- 
tion is often felt at the pit of the stomach, which nothing appeases 
but almost constant eating. The abdomen becomes tumid, and 
a sensation like something revolving in one portion of it, is some- 
times experienced, more especially in one of the sides. The 
head is often affected with pain or vertigo; and, in females, a 
train of most distressing nervous symptoms are produced: in 
one, we saw repeated attacks of convulsions, resembling epilepsy, 
assail the patient, from which she was not altogether relieved by 
the expulsion of the worm, which measured nearly seven yards. 
The complexion becomes sallow and wan ; the eyes sunken, with 
widely dilated pupils. This worm, however, rarely attacks chil- 
dren; therefore, its treatment does not properly belong to us — 
but for this we would make no apology, had we any thing new to 
offer upon the subject of its cure. The remedies on which the 
most reliance is at present placed, are the spirit of turpentine, 4 
the male fern, powdered tin, and the cowage. The worm expelled 
by the lady who became epileptic, was driven off by drinking 

sweetened milk, to children from two to four years old; thirty, to these from five 
to seven ; and, to adults, a tea-spoonful. 

'Lime-water may be used, of its ordinary strength, every evening: from half a 
gill to a gill, (a little warmed,) will be sufficient. Dr. Darwall says, for the 
removal of ascarides vermiculares, or thread-worm, " The most useful injection 
is composed of warm water and the tincture of the muriate of iron; half a pint of 
the former to half an ounce of the latter ; and the whole of this thrown at once up 
the rectum. There are few cases so obstinate that this will not suffice to over- 
come. It will be necessary to clear out the upper portion of the canal at the same 
time, by an active purgative." Plain Instructions for the Management of In- 
fants, $)-c. p. 99. 

a From five to ten grains of finely powdered camphor, suspended in a wine- 
glassful of thin starch, may be given twice or thrice a week, at bed-time ; or two 
or three tea-spoonsful of the camphorated spirit may be combined with the lime- 
water. 

3 An enema of a tea-spoonful or two of the elixir proprietatis, in a wine-glassful 
of warm milk, may be used two or three times a week at bed-time. 

4 We have, within a year, prescribed for a tape-worm, with great success, in a 
very athletic man, when in health, but who had become much reduced by this 
animal. He was ordered an ounce of castor oil, combined with as much of the 
spirit of turpentine, once a week, for three consecutive weeks. The medicine 
acted upon his bowels with great force each time it w T as taken; and, each time, 
brought away very large portions of the worm — nay, to the amount of many yards. 
Since writing the above, this patient called upon us, under the apprehension that 
all the worm was not discharged. He was again directed to use the same remedy, 
to which he readily assented. 



OF SCARLET FEVER. 433 

every morning, for seven days, a pint of a saturated solution of 
common salt. 1 

1675. Some children are very much more disposed to gene- 
rate these vermin than others : so much so is this the case, in many 
instances, that they may be said to be almost always present. As 
the disposition to cherish these animals seems to consist in a weak- 
ened condition of the stomach and bowels, we always make it a 
rule, with such constitutions, to give tonic medicines after these 
animals have been expelled, either in part, or altogether. The 
best with which we are acquainted, consists of equal parts of the 
carbonate of iron, and common salt ; from ten to thirty grains, 
according to the age of the child, of this compound, must be 
given, for twelve consecutive mornings. It is best exhibited in 
molasses; and should be taken early in the morning, fasting. — 
A diet of animal food, chiefly, should be observed. Milk is also 
a very popular article of diet at this time. 



CHAPTER XXXIY. 

OR SCARLET FEVER. 

1676. This is so denominated on account of the peculiarly 
florid appearance of the skin, by which it is accompanied. In 
some one of the several forms, which we shall presently see it 
puts on, this complaint has, from an early period, occupied no 
inconsiderable share of attention. It is frequent in its occur- 
rence, extensive in its prevalence, and at times exceedingly fa- 
tal in its terminations. The complaint prevails more in winter 
and spring, than in summer or autumn ; attacking children in 
preference to those who are more advanced in years. 2 By the 
nosological writers it is divided into three forms, which are to 
be regarded, however, as nothing more than the same disease, 
marked by dhTerent degrees of violence: — -the scarlatina sim- 
plex — scarlatina anginosa — and scarlatina maligna. To many 
the latter is more familiar under the name of the malignant or 
'putrid sore throat. 

1677. By scarlatina simplex is to be understood the simple 

1 It would appear that this worm is much more frequently met with in England 
than in this country; as Dr. Darwall, (Plain Instructions for the Management of 
Children, &c, p. 102,) says that his cases "exceeded some hundreds." Louis re- 
ports ten cases; and our own proper experience would not allow us to say with 
certainty that we have met with more than a dozen cases, in more than forty years 
of practice. 

* Sir Gilbert Blane says that he never saw a person turned of forty affected by it. 

28 



434 OF SCARLET FEVER. 

constitutional disease, without any morbid affection of the throat. 
By scarlatina anginosa, a higher degree of the same complaint 
— the throat being at the same time inflamed and swollen. By 
scarlatina maligna, the same disease, in still greater violence — 
the throat being affected, or otherwise, and the symptoms ma- 
lignant. 

1678. It is unnecessary to enter into an elaborate discussion, 
to establish the identity of the disease. 

1679. Like most other fevers, scarlatina commences with chil- 
liness, fulness of the head, and lassitude ; to which succeed pros- 
tration of strength, which at times is very great, and nausea 
or vomiting. The surface soon becomes florid and hot, and on 
examining the throat, it will sometimes be found inflamed, and 
the same red appearance extends to the tongue. 1 There is of- 
ten, at this time, more or less catarrhal affection ; the head suf- 
fers severe pain, particularly about the frontal sinuses ; and with 
which is sometimes associated a disturbance of the intellectual 
faculties. The degree of these symptoms indicates, with suf- 
ficient exactness, the strength and character of the forming dis- 
ease. Being very slight, the complaint will be simplex; if less 
so, the anginosa; and where they are severe and threatening, 
the malignant, 

1680. In the worst variety of scarlatina maligna the com- 
mencing symptoms are alarmingly violent. The attack is, for 
the most part, sudden ; the patient becomes pale, sick, and faint ; 
the head is giddy, heavy, and confused, rather than severely 
pained; the oppression about the praecordia is extreme, the heart 
palpitates, the stomach suffers great uneasiness, though there may 
be no vomiting — this organ being probably prostrated below the 
power of reaction. The face is pale or livid ; the eyes exhibit a 
glairy appearance, and are marked by a fatuitous or inebriated 
expression. "A remarkable tumefaction of the fingers some- 
times takes place, which, with the erysipelatous tinge they soon 
acquire, is often of itself sufficient to characterize the disease." 
Gregory. This is seen also in some mild cases. 

1681. On the second or third day from the commencement of 
the disease, the febrile symptoms are considerable ; the skin be- 
comes morbidly sensible to the touch, and begins to be covered 
with an efflorescence, or florid eruption. 2 About the same time 
a degree of redness and swelling appear in the fauces. The skin 
becomes excessively hot ; and more so, perhaps, than in any other 
form of febrile disease. The pulse is very frequent, rarely be- 
ing under one hundred and twenty strokes a minute. 

1 This last presents a very peculiar aspect. Through the fur with which it is 
covered, the elongated papillae project their points, and are of an intensely' deep 
scarlet blue. 

2 The tone of colour is said to be that of a boiled lobster. 



OF SCARLET FEVER. 435 

1682. The reaction of the system being now completely de- 
veloped, the pulse exhibits the character which belongs to the 
existing form of the disease — preternaturally frequent, quick, 
and active, though still moderate, if the disease be simple — more 
frequent, irritated and tense, if it be anginose — of greater fre- 
quency still, but not so full, resisting, and firm, if it be malig- 
nant. The temperature of the body, the thirst, the scurf on 
the tongue, are also graduated in the same way; each symptom 
increasing in intensity according to the augmented violence of 
the case. 

1683. The eruption assumes, at times, the form of red points, 
though generally that of red patches, which spread and unite, 
so as to cover the whole surface. It appears first on the face 
and neck, and, in the course of a short time, spreads gradually 
to the lower extremities. The redness is often considerable 
about the loins, and the bending of the joints, and on the hands 
and ends of the fingers, which feel stiff and swollen. The erup- 
tion is not very regular, either as to the time of its appearance, 
its steadiness, or its duration. It usually continues about four 
days, and goes off with desquamation of the cuticle. As the dis- 
ease proceeds, the neck and lower jaw grow stiff, the tonsils swell 
and become marked with specks which degenerate into ulcers, 
covered with superficial, ash-coloured sloughs. These sloughs, 
in favourable cases, separate and come off, about the eighth or 
tenth day, when the ulcers underneath are fresh and florid, and 
heal kindly. The fever, at the same time, gradually abates, and 
a great amendment becomes apparent. 

1684. But, in the more malignant cases, the course of the dis- 
ease is very different. The sloughs on the tonsils grow fouler; 
and the discharge from them and the nostrils becomes exceed- 
ingly acrid. The mouth assumes a dark colour, and is often in- 
crusted with a black or brown fur. The breath is extremely of- 
fensive ; a tenacious mucous secretion infests the fauces. The 
eyes and nostrils furnish an acrid serum. Hemorrhages some- 
times take place from these parts, as also from the bowels ; di- 
arrhoea of a severe kind is often found present ; so also de- 
lirium or coma. If the throat be examined, it will be found stud- 
ded with more or less sloughs, with dark or livid bases. The 
parotids are swelled and tender to the touch. Painful indura- 
tion of the glands of the neck, which sometimes terminate 
in large suppurating abscesses ; tenesmus, and diarrhoea ; which 
sometimes speedily sink the patient, if not early removed. 

1685. This is reputed to be a contagious disease. On this 
point, however, the evidence, to say the least, is equivocal. The 
fact3 connected with the spreading of scarlatina seem to be per- 
fectly explicable on the ground of its being epi& 



436 OF SCARLET FEVER. 

contagious. 1 In this country the belief that it is a contagious dis- 
ease is by no means so general as it is in Europe, and especial- 
ly as it is in Great Britain. I have never seen, so far, any de- 
cided proof that it has communicated itself in any one instance. 
On the contrary, I am strongly disposed to doubt its contagious 
quality. I attended a child with scarlatina anginosa, in a fami- 
ly of eight children; the child that was ill was constantly sur- 
rounded by the well children, yet not one of these sickened af- 
terwards with this disease. The same thing precisely occurred 
in my own family; besides many less remarkable instances. 
Gregory says, " The slowness of its diffusion is one of the most 
remarkable circumstances in its history." Vol. I. p. 237. 

1686. As regards the prognosis, it is unfavourable in propor- 
tion to the malignant character of the disease. Thus, great 
prostration of strength; delirium, or coma; extreme restless- 
ness; a distillation of very acrid sanies from the nose; a purple 
or livid appearance of the fauces, without tumefaction, inter- 
spersed with white specks, or dark sloughs, attended by a diarrhoea 
of acrid matter; and, above all, a change of the efflorescence to a 
mahogany colour, are mortal, or extremely alarming symptoms. 
The termination of this disease is sometimes exceedingly abrupt 
and unexpected. We have known death to take place in several 
instances, and this most suddenly, where every hope was enter- 
tained of recovery 2 but a short time before. The favourable 
signs in scarlet fever are, the patient surviving the ninth day, 
without any decided mortal symptoms ; the intensity of the colour 
of the skin abating gradually; desquamation of the cuticle, and 
the departure of the swelling from every portion of the body to 
which it had extended; the separation of the sloughs, with a 
healthy appearance of the parts from which they separated; 
pulse becoming slower and less irritated; heat abating; urine 
depositing a lateritious sediment, refreshing sleep, and return of 
appetite. 

1687. In its simple form scarlet fever calls for very little 
medical aid. An emetic of ipecacuanha or antimony; purging 
with calomel, and afterwards with some one of the neutral salts ; 
venesection, in case of fulness and pain in the head; the mild 
diaphoretics, aided by diluent drinks; and a regulated diet, 3 are 

The weight of European authority is perhaps against us; and in actual prac- 
tice it will be safest to act under such a conviction. We are, indeed, told that 
the power of infecting endures for a considerable time — certainly for a week or 
two after the cessation of the efflorescence, and probably as long as the desqua- 
mation of the cuticle lasts. Persons who have been exposed to the contagion have 
the disease, it is said, to break out on the fifth or sixth day. 

3 When the disease is very malignant, death sometimes takes place on the third 
or fourth day; while, in its milder forms, it will linger on to the second or even 
third week. Generally, however, the patient is safe after the ninth day, under 
either form of the disease. 

• By a regulated diet, we mean a strict antiphlogistic one; that is, an entire 



OF SCARLET FEVER. 437 

all we need prescribe. But in the anginose state of the disease 
more is required — the treatment here must be circumspect and 
vigorous ; and much reliance is to be placed on the thorough 
evacuation of the alimentary canal. Unless, as is sometimes 
the case, the violence of the symptoms calls for the immediate 
use of the lancet, let the treatment commence by puking with 
the ipecacuanha. Emetics are of the highest importance; and 
may sometimes be repeated during the course of the disease, 
should the symptoms be obstinate. 

1688. The emetics should be followed by laxatives. Calomel 
would seem to be the most suitable, on account of its tendency 
to prevent and remove congestions of the abdominal viscera, 
which are much to be dreaded, and vigilantly guarded against, 
in this disease. This is a disease in which congestions of the 
great viscera are very apt to occur; and it requires mercurial 
purging to unload the vessels, and restore the balance, which is 
thus destroyed in the circulation. In the more advanced stages 
of the disease, however, provided the bowels have been already 
fully evacuated, some of the milder purgatives may be employed. 
The best mode of exhibiting calomel is in divided doses — say, 
six or eight grains divided into six parts; one part to be given 
every hour, until the whole be taken ; unless the previous quantity 
may have answered. Should this quantity, however, fail to move 
the bowels, it must be followed by two or three tea-spoonfuls of 
calcined magnesia, mixed in a little sweetened milk, and drink- 
ing after it some lemonade. 

1689. In case the pulse be full, tense, or hard, immediate re- 
course is to be had to venesection. The quantity of blood drawn, 
and the repetitions of the operation, are to be directed, of course, 
by the judgment and experience of the practitioner. The relief 
felt by the patient, the appearance of the blood, and the effect 
on the pulse, must determine whether it shall be repeated — the 
bleeding must be followed by purging. In the early, or inflam- 
matory condition of scarlatina, however, when there is conside- 
rable arterial action, and vast augmentation of heat on the sur- 
face, cold ablution, or sponging, gives great relief to the symp- 
toms, and is a most comfortable process. We prefer, however, 
sponging to ablutions. Some, however, are afraid of these cold 
applications, because the throat is sore ; but this forms no excep- 
tion ; for it is not accompanied by cough or other pneumonic 
symptoms, like measles; and the sponging, or even effusion, has 
checked the sore throat most evidently. We would, however, 
make an exception to the employment of cold water, &c, when 
they produce chilliness: in this case, tepid water may be sub- 
stituted. 

forbearance from animal food; from every kind of liquor, whether fermented or 
distilled; and from spices of every species. 



438 OF SCARLET FEVER. 

1690. We are told the warm bath is exceedingly efficacious 
when the eruption imperfectly takes place, owing to general 
languor; and, especially, when attended by coldness of the sur- 
face; or, having appeared, suddenly recedes, inducing great gas- 
tric distress, and other very unpleasant symptoms. To cleanse 
the foul ulcers of the throat, emetics are found most effectual; 
the emetic may be followed by the use of detergent gargles ; the 
best of which are composed of Peruvian bark, with a portion of 
the tincture of myrrh, or barley water, acidulated with the sul- 
phuric or muriatic acid, with the addition of honey. An infusion 
of Cayenne pepper, alone or mixed with barley water, or the 
decoction of bark, is much, and we have reason to believe, not 
too much praised as a gargle, 1 as far as we can rely on our own 
observations. 

1691. In the malignant form of this disease the general prac- 
tice is nearly the same as in the preceding or anginose state. 
We rely, mainly, on evacuations of the primse via — first, by 
emetics, and next with the mercurial purges. 2 

1692. Whatever may have been the primary form of the dis- 
ease, in the advanced stages, when appearances of great depres- 
sion supervene, we have recourse to nearly similar measures. 
The object is to support the enfeebled system, which is best ac- 
complished by the carbonate of ammonia, camphor, turpentine, 
bark, and wine — aided by the ordinary external irritant appli- 
cations. 

1693. Long after the cessation of the active symptoms, there 
are certain consequences that show themselves, to which our at- 
tention should be immediately called. Deafness is one of these : 
this proceeds from inflammation having invaded the Eustachian 
tube, and leaving it in a state of obstruction. It is an unplea- 
sant affection, though we have never known any permanent mis- 
chief to result from it : it requires no treatment. 3 (Edematous 
swellings of the lower extremities are common, as well as more 
serious inconveniences. The best treatment is to purge mode- 
rately, and afterwards exhibit the digitalis. It is here that this 
drug sometimes proves pre-eminently beneficial. But in the re- 
moval of the effusion, it may be aided by frictions and bandages, 
if the swelling be large, and by exercise duly regulated, and 
persevering in a milk and vegetable diet. We have known the 
inflamed parotids run on to extensive suppuration, and require 

1 We are in the habit of using Cayenne pepper gargle in the incipient stages of 
anginose affections, with the most decided advantage; and, in the disease under 
consideration, it seems to us to be the only remedy that affords relief, if ulcera- 
tion have not taken place. 

* See American Journal of Medical Sciences, for August, 1833, for Dr. Jack- 
son s account of the use of ice in this disease. 

3 Dr. Gregory, however, states, that " not unfrequently permanent deafness is 
left by it." Vol. I., p. 240. Of this, however, we have never seen an example. 



OP MEASLES. 439 

much time for healing. When this takes place during the con- 
tinuance of considerable fever, and the parts exposed by slough- 
ing look as if they had been carefully and beautifully dissected, 
death has constantly followed, as far as our observations have 
extended. 

1694. Dropsical affections frequently succeed to scarlet fever : 
this takes place after the mild as well as after the severer form 
of this disease. We are inclined to believe that this affection 
arises from the accompanying inflammation not having been 
properly subdued by early depleting remedies. In consequence 
of this, the inflammation acquires a chronic, or a sub-acute form, 
which is only relieved by purging, by blood-letting, and diuretics 
of the saline kind ; as nitre, or nitre and squills. For children 
under seven years, and above three, we would give eight grains 
of nitre, and one-fourth of a grain of squills three or four times 
a day. For those above seven, to fifteen, twelve grains of nitre, 
and half a grain of squills may be given ; from fifteen to adult 
age, from fifteen to twenty grains of nitre, and a grain of squills 
may be administered. 



CHAPTER XXXV. 



1695. This disease occurs, for the most part, in the winter 
and in spring; at least, its appearance is much more frequent 
at these periods than at other portions of the year. It may, 
however, prove epidemic in the summer. This disease is evi- 
dently influenced by the state of the weather; it is more mode- 
rate in mild than in severe weather. 

1696. It is the opinion of some that measles is regular in its 
recurrence as an epidemic ; the interval is said to be seven years. 
Whether this be rigidly the case, we are not prepared from pre- 
sent data to decide : it is, however, rendered probable that there 
is either a regular return at this period, or, at least, an approxi- 
mation to it. 

1697. It is said to be contagious ; but this may be pretty fairly 
disputed, notwithstanding the imposing experiments of Dr. 
Home. This physician declared he had propagated this disease 
by inoculation. An Italian physician, (Speranza,) declares he 
has succeeded in an attempt at inoculation by puncturing a full 
measle with a lancet, and inserting the blood that was yielded 
by the puncture — he declares he was successful in six cases. On 
the other hand, Dr. Chapman (MS. lectures,) says upon this 



440 OF MEASLES. 

point, that "experiments of this nature were instituted in the 
practice of our Dispensary in 1801 ; in which the blood, the tears, 
the mucus of the nostrils and bronchia, the eruptive matter in 
the cuticle, properly moistened, were all tried, and without suc- 
cess in any one instance." 

1698. Neither is it settled whether the constitution can be 
made to suffer the rubeolous action a second time ; evidence is 
so entirely contradictory on this point, that it would not be safe 
to draw a positive conclusion either in favour of or against it. 
One thing, however, we may safely declare ; that if it be taken 
a second time, it is contrary to the ordinary character of this 
disease; 1 or, in other words, it is but an exception to the general 
rule, as regards several of the diseases which propagate them- 
selves by specific contagion, as small-pox, cow-pox, whooping- 
cough, chicken pox, &c. For it is now well ascertained, that 
exceptions do occur — we have ourselves known each of the dis- 
eases just enumerated, repeated, seemingly so unequivocally as 
to leave no doubts in our mind upon the subject. 

1699. The measles are ushered in like other febrile affections 
by chilliness, languor, oppression, heat, and thirst, especially the 
first day : these terminate in a perfectly well-formed fever, and 
sometimes by sickness, and even vomiting. The fever is pretty 
high from its first assault, but not regularly so ; occasionally it 
would seem to augment for two or three days together, and be- 
comes very considerable at the time the eruption makes its ap- 
pearance, which, usually, is not before the fourth day. 

1700. Cough, a little hoarseness, slight sore throat, pain in 
the chest, and difficulty of breathing, are the usual attendants 
upon this disease. The eyes are particularly affected ; they are 
almost always slightly inflamed, and the lids a little swelled ; 
and these are attended by a plentiful secretion of scalding tears. 
Sydenham looks upon these symptoms as the most certain marks 
of the approach of the measles. The discharge from the nostrils 
is also abundant, as well as acrid, sometimes. Sneezing is almost 
a never-failing attendant upon this complaint. 

1701. The eruption almost always occupies the face and neck 
before it is observed elsewhere : it, however, for the most part, 
spreads itself successively over the whole body. But should this 
not strictly occur, and the eruption show itself in "large red 
spots, not rising above the surface," it may, nevertheless, be 
genuine measles. 2 This eruption is mostly very florid, and it 

1 There is a variety of this disease, however, which affords no protection against 
the genuine measles : this is called the French measles, or the rubeola sine ca- 
tarrho. Dr. Gregory says this " is a very rare variety, and only interesting in a 
pathological point of view." We have had several opportunities to see this form 
of measles. Dr. Hosack witnessed it in 1813 in New York. It has never re- 
quired any active treatment so far as we have observed. 

9 Sydenham, Vol. I., p. 257. 



OF MEASLES. 441 

retains this colour for the first three or four days, after which 
time it becomes brownish, and then gradually vanishes : this is 
followed by a desquamation of the cuticle. "These red spots 
are composed," agreeably to the same author, "of small red 
pimples, seated near each other, and rising a little higher than 
the surface of the skin, so that they may be felt upon pressing 
them lightly with the finger, though they can scarcely be seen. 1 

1702. The eruption does not much abate the severity of the 
fever; at least the heat of the skin remains equally great, and 
especially that of the head and neck, both of which have a look 
of greater fulness than is natural. Sometimes, however, an 
abatement of fever may be observed after the completion of the 
eruption ; but, for the most part, it does not entirely cease until 
the cuticle is cast off. The vomiting which usually accompanies 
or ushers in the disease, always ceases at this period ; but the 
fever and cough seem rather to augment, and are very frequently 
accompanied with drowsiness. 

1703. We have said cough was an attendant upon this com- 
plaint; indeed, it may be said to be of never-failing occurrence. 
It is in the commencement dry, frequent, and sometimes pain- 
ful ; but as the fever declines, it becomes more open, and often- 
times the expectoration is even great. 

1704. Pneumonic symptoms very frequently attend measles; 
and sometimes this disease, when epidemic, is characterized by 
this tendency. We remember it to have been epidemic early in 
the spring of 1785 or 1786; — at which time almost every case 
was marked by pneumonic symptoms, of greater or less violence. 
This disease was of difficult management ; it ran its course with 
unusual rapidity, and not unfrequently terminated in death; 
and in all instances, almost, the cough was severe, obstinate, 
and of very long duration. Indeed, in many cases, it yielded 
but to the genial heat of advancing spring, or even that of 
summer. 

1705. The only disease with which measles can well be con- 
founded is scarlatina; yet it is pretty easily distinguished from 
it by attending to the characters of each. The sneezing, the 
watery eyes, the severe cough, the pneumonic tendency, all serve 
to distinguish the measles from scarlatina. Besides, in measles, 
there is less swelling in the skin ; the redness is not so uniform, 
nor is the tone of colour precisely the same. For in scarlatina 
the tone of colour on the skin is much more vivid than in measles, 
and seems to lie beneath the cuticle — it is truly a scarlet colour. 
In measles, the eruption has a mixture of the Modena with the 
scarlet — that is, it has a shade of purple. Besides, in measles 
there is a little roughness to be perceived if the hand be slowly 

1 Sydenham, Vol. I., p. 257. 



442 OF MEASLES. 

passed over the skin that is occupied by the eruption ; which is 
not the case generally, indeed very rarely, with scarlatina. 

1706. In measles the eyes are much more sensible to light, 
and are very much more tearful, than in scarlatina, nor are the 
fauces so much affected in the former, as in the latter disease. 
Indeed, we have seen many cases of genuine measles without the 
throat being at all affected, which rarely happens with scarlatina. 
In measles, there is less certainty of a desquamation of the skin. 
In the former, it more resembles a branny scurf than a true 
desquamation. 

1707. As regards the prognosis, it may be observed that this 
disease is dangerous in proportion as the head, the lungs, and 
the stomach may be affected. And in habits disposed to con- 
sumption it is always bad; at least, it is always to be feared. 

1708. Much fever without a corresponding quantity of erup- 
tion ; or the latter making its appearance reluctantly, or of a 
pale or livid colour, is always a bad sign, and is usually attri- 
buted to a want of vigour in the constitution ; but this is not so 
without exception ; or, perhaps, it is very rarely the case. We 
shall again advert to this condition, presently. 

1709. The abrupt disappearance of the eruption, or its be- 
coming pale, is unfavourable, especially during the first day or 
two of the eruption ; or, if it be attended by a severe vomiting, 
a great tenderness of the epigastrium, or diarrhoea. Should 
none of these untoward symptoms take place, the case will most 
probably terminate propitiously. But we must be upon our guard 
not to mistake the ordinary progress of the disease for a retro- 
cession of the eruption. For, as the disease usually runs its 
course in eight or nine days, the eruption is observed to disap- 
pear pretty generally at this time, which by the ignorant is sup- 
posed to have taken place much too soon, and with a view to 
maintain it upon the skin, stimulating drinks and medicine are 
freely exhibited ; the patient is covered warmly from head to 
foot, and every avenue for air carefully shut up. In consequence 
of such treatment, the patient is thrown suddenly into imminent 
danger — fever is rekindled; cough and other pneumonic symp- 
toms increase; and the eruption assumes a livid or black hue, 
and, if not soon relieved by proper treatment, the patient quickly 
dies. 

1710. Measles seems to be more decidedly attended by that 
condition of the system called inflammatory, than almost any 
other of the eruptive diseases ; or, in other words, its epidemic 
character is more frequently inflammatory than otherwise. 
There are exceptions, of course, imposed by constitution, and 
season of the year ; but, above all, by the epidemic peculiarity 
of the atmosphere : hence, it is sometimes highly inflammatory ; 
requiring the most active evacuations, and extensive depletion 



OF MEASLES. 443 

by blood-letting, &c, to keep it in control; while, again, it may 
have a highly malignant character; for the relief of which we 
must have recourse to the opposite means. Sydenham, however, 
did not order bleeding in the beginning, nor even at the height 
of this aifection, though so fond of this remedy, under almost 
every circumstance, at other periods of the disease. This, in 
our opinion, shows how discriminating this great man was — for 
he would not prescribe for the name of a disease: the epidemic of 
1670 does not appear to have been highly inflammatory, as a 
strict antiphlogistic regimen, with demulcents, he informs us, 
"seldom failed to cure the disease." 

1711. Therefore regard must be had to the character the 
measles assume, and must be treated accordingly; if fever be 
high, cough and oppression severe, blood should be drawn imme- 
diately, though these symptoms occur at rather an uncommon 
period of the disease, namely, in its forming stage ; for such 
changes may be imposed upon the character of measles by some 
constitution of the air, or other cause, as to render this opera- 
tion occasionally necessary. 

1712. From this view of the constitutional differences of mea- 
sles, it will at once appear that its treatment must vary accord- 
ing to its specific character ; or its form may be so mild as to 
require no medical treatment. We have been under the neces- 
sity of bleeding only once this season for this disease, though we 
have prescribed for more than one hundred, up to this time; 
(April, 1829,) so mild has the character of measles been. 

1713. In attacks of severity, especially where much cough, 
oppression, or pain in the chest attend, the first remedy we can 
profitably use is blood-letting; the quantity must be regulated 
by the age of the patient, the force of the disease, and the im- 
mediate effect of the remedy. It must, however, be remarked, 
that in measles, though we are obliged to repeat this operation, 
it rarely requires large quantities to be drawn at a time; and 
the repetition must be governed by the state of the pulse, and 
continuance of the violent symptoms. 

1714. Much objection is made to bleeding in the measles by 
some : this fear is without foundation in most cases of this com- 
plaint; for, as a general rule, we may declare that there are 
few diseases which more decidedly require this remedy, as there 
are few in which the lungs are so seriously implicated. Under 
the best management, it is but too apt to leave a troublesome 
and obstinate cough behind ; but this is sure to be augmented, if 
blood-letting has been neglected where the case required it; and 
we may most safely add, that this but too frequently happens, 
since thi3 operation is too often proscribed. 

1715. It is true, if we are to believe authors, that now and 
then the character of this epidemic is such as to forbid, in almost 



444 OF MEASLES. 

every case, blood-letting; but this is but the exception to the 
rule. And we are disposed to believe that these exceptions in 
many instances have been imaginary; or rather, that the true 
mode of treatment has been ill understood. Sydenham appears 
to us to be authority for this belief; for we are of opinion that 
few would have bled under the circumstances in which he declares 
he found the maid servant of "Lady Anne Barrington, who had 
the measles, joined with fever, difficulty of breathing, purple spots 
over the whole body, and many other dangerous symptoms ; all 
of which," says he, " I ascribed to the hot regimen and medicines 
which had been too freely used. I directed bleeding in the arm, 
and prescribed a cooling pectoral ptisan to be taken often ; by 
means of which, and a more cooling regimen, the purple spots, 
and all the other symptoms went off by degrees," p. 264, Vol. I. 
There are few diseases which put on a menacing appearance that 
are worse treated than measles, especially when the eruption is 
about to make its appearance. Should this fail to be as rapid 
in its progress, or as extensive in its diffusion, as meets the views 
of some old woman, or ignorant nurse, the disease is almost sure 
to be converted, by stimulating applications, into one of danger, 
however simple it might have proved, had its course and tendency 
been undisturbed. With a view to promote an eruption, heating 
teas of various kinds, and even liquors are given, to the certain 
injury, if not to the absolute destruction, of the patient: this 
conduct cannot be too strongly reprobated, nor too peremptorily 
forbidden. 

1716. The same error is committed almost always, where the 
eruption seems tardy or reluctant in its appearance; for it is 
wrongly imagined that this can only proceed from a want of force 
in the system, and that the efforts of nature must be seconded 
by heating teas of various kinds, wine whey, milk-punch, &c, 
when nothing could have relieved the oppressed system but blood- 
letting, and other evacuating remedies ; and hence we are dis- 
posed to believe this disease so frequently proves fatal. For if 
the pathology of the measles now so generally assumed be true, 
the cause of the eruption not appearing upon the skin may be 
owing to the intensity of the gastric irritation or inflammation, 
as we have already attempted to explain, and which may require 
the loss of blood, either from the system at large, or from over 
the region of the stomach, by leeching, or cupping. 

1717. In aid of the bleeding we should employ calomel, so as to 
freely discharge the bowels, without urging them to brisk purging ; 
and also prescribe a strict antiphlogistic regimen; together 
with demulcent drinks, as flax-seed tea, barley water, hran tea, 
gum Arabic tea, &c. It may also become necessary, where the 
pneumonic symptoms continue after bleeding, to draw blood from 
near the seat of the local affection by cupping, and this to be 
followed by a blister. 



OF MEASLES. 445 

1718. When the system is sufficiently reduced to bear opium 
in some form or other, it should be administered, so as to ap- 
pease the cough, which but too often is very distressing. 1 

1719. One of the best forms of giving opium is that of the 
"black drop," or the acetated tincture of opium. This should 
be administered at night, in combination with antimonial wine, 
in suitable doses ; for instance, a child from two to four years of 
age may take three or four drops of the black drop, with ten of 
antimonial wine at bed-time; and, should this not relieve the 
cough, and appease the inquietude, in two hours it may be re- 
peated; for children more advanced, we must increase the dose 
a little. But a few trials of rather an under dose will soon lead 
to the knowledge of the required quantity. 

1720. For children under two years old we have found the 
syrup of poppies to answer admirably. This may not only be 
given at night, but also in the day, and may most advantageously 
be repeated, as the necessity arises : from a small tea, to a pap- 
spoonful, will be sufficient for a child from six months to two 
years old. 

1721. Should the character of this disease be typhoid, 2 the 
lancet must be sparingly used, and, perhaps, not at all, except 
in the beginning ; but when there is much oppression or pain in 
the chest, with much cough, cupping will be found both neces- 
sary and advantageous : this must, for the most part, be followed 
by blistering. 

1722. Emetics are also useful in this species of measles, and 
should be employed where there is a great accumulation of 
phlegm, and the expectoration but inconsiderable. Mercurial 
purges are also to be given, even to plentiful purging. It is 
useful also sometimes to employ the warm bath, especially where 
the character of the eruption is not sufficiently healthy ; looking 
either too pale, or livid, provided the pulse is not so active as to 
require bleeding. 

1723. Should the appearance of exhaustion supervene, we 

1 We have found the following mixture answer admirably well : — 



R 


Sperm. Ceti. 


3iss. 


Take of Spermaceti 


1± dram 




Vitel Ovi. 


j. 


Yelk of an Egg 


One. 




Pulv. G. Arabic, 


SO; 


Powdered Gum Arabic 


2 drams. 




Elix. Paregor. 


Zvi. 


Paregoric elixir 


6 « 




Vin. Antim. 


^ss. 


Antimonial Wine 


4 « 




Sacch. Alb. 


3"j. 


White Sugar 


3 " 




Aq. Font. 


3 v j- 
M. 


Water 


6 oz. 
M. 



Of this a table-spoonful is to be given every two or three hours, until the cough 
be relieved. This dose is calculated for an adult— for children the quantity must 
be proportional. 

* We are of opinion that too much care cannot be taken not to confound what is 
termed "a typhoid condition," with an existing inflammatory condition of the 
system: witness the case related by Sydenham, p. 48y. 



446 OF MEASLES. 

must have recourse to the diffusible stimuli, as wine whey, and 
the volatile alkali; and these may be aided by blisters to the 
extremities, or by sinapisms to the soles of the feet. 

1724. It is of much consequence, throughout the whole course 
of this disease, that the temperature of the air of the patient's 
chamber should be regulated, and not made to exceed sixty-four 
or five ; sixty, perhaps, would be the best standard. This tem- 
perature would be warmer than would be useful for small-pox — 
measles requires this ; but it is never proper to keep the patient 
hot, by either a heated atmosphere or bed-clothes. The constant 
disposition to cough will readily explain why measles requires a 
higher temperature than small-pox. Dr. Gregory observes, that 
"It is well ascertained that these (the symptoms of thoracic in- 
flammation) are often aggravated by a free exposure of the body 
to cold, either during or previously to the eruption ; and some 
have remarked that this aggravation of the catarrhal symptoms 
is occasionally attended by a recession of the eruption. Mode- 
rate warmth, therefore, is on all accounts advisable in measles." 

1725. Measles but too frequently leave disagreeable conse- 
quences behind them, especially cough. This secondary or su- 
pervening cough, is too often neglected, owing to the belief that 
more or less must necessarily follow this disease. This affection 
takes place after the patient has gone through the eruptive stage ; 
and dissection reveals that it is owing to an inflammation having 
attacked the mucous membrane of the bronchia. This com- 
plaint comes on sometimes so insidiously that it makes a fatal 
progress before danger is apprehended. We should, therefore, 
never trust, to nature and time, a patient in whom considerable 
difficulty of breathing exists, accompanied by a wheezing. Nor 
must we be deceived because the cough is not severe; for, in 
some of the worst cases, the cough is not always violent. The 
cough, for the most part, is dry and fatiguing, and comes on by 
paroxysms. The pulse is hard, for the most part, and always 
frequent ; thirst great ; tongue loaded ; bowels constipated, and 
a hot skin. This is a state of great danger; the bronchia are 
soon filled with mucus, and the patient dies from the failure of 
the due oxygenation of the blood. This complaint must be treat- 
ed as an acute bronchitis. A deranged state of the bowels may 
also follow, particularly if the disease have been ill-managed, by 
over stimulating, by exposure or improper diet, too soon after 
the fever has passed away. On this account, a patient recover- 
ing from this disease should never be exposed to cold or damp, 
and should be confined for some time to a milk and vegetable 
diet, and made to wear, in cold or cool weather, flannel next to 
the skin. Sydenham informs us that the diarrhoea following 
measles has always been best relieved by blood-letting. 1 

'There is a curious circumstance mentioned by Dr. Tourtual, a Dutch physi- 



OF NETTLE RASH. 447 

CHAPTER XXXVI. 

OF URTICARIA, OR NETTLE RASH. 

1726. This very troublesome and oftentimes obstinate com- 
plaint is wont to attack children who are teething, or who in- 
dulge much in acescent food, or fruits, in the summer season 
especially. Dr. Good defines the idiopathic species to be — 
iw Rash in florid, itching, nettle-sting wheals; appearing about 
the second day ; irregularly fading and reviving, or wandering 
from part to part; fever a mild remittent." Vol. II. p. 384. 

1727. This definition may be correct in what Dr. Good calls 
the idiopathic form of urticaria ; but there are some remarkable 
deviations from it. We have seen many instances of this com- 
plaint come on very suddenly, when certain substances have been 
taken into the stomach, and which was only relieved by such sub- 
stances being again discharged from it. We know a gentleman 
in whom this complaint has been several times produced by eat- 
ing of very young boiled chicken; (when roasted or broiled, they 
would not affect him ;) by boiled young cabbage in the spring of 
the year, and by a draught of cold lemonade when the body is 
over-heated. After either of these substances is received into 
the stomach a few minutes, he becomes violently sick ; will vomit, 
and in a moment be covered with wheals, which will remain un- 
til he effectually cleanses his stomach of the offending matter. 
This affection is rarely idiopathic — at least, we have never seen 
such a state of the skin; though both Good and Plumbe make 
the distinction. Mr. Plumbe says, "Notwithstanding the very 
general origin of urticaria in temporary or accidental disorder 
of the system, it often occurs as an idiopathic affection, or, in 
other words, as a consequence merely of extraordinary irritability 
of the skin ; and hence some persons can produce it with slight 
friction on any part of their body, even where no suspicion of 
the slightest derangement of the function of any organ can be 
ascertained." — Practical Treatise on the Diseases of the Skin, 
p. 272. 1 

1728. Dr. Hewson mentions several cases of eruptions which 
arose from taking balsam of copaiva : some resembled the wheals 

cian, which, if proved to be a fact, will be highly interesting in the history and 
treatment of measles. He states that at a period when measles was epidemic, 
all the children who were under treatment with sulphur for the itch, escaped the 
disease; and that those who were taking sulphur for the whooping cough enjoyed 
the same immunity. Also, he says, that many children who were taking a mix- 
ture of sulphur and camphor, and to whom these medicaments were applied by 
frictions, were not attacked by measles, while those who were not subjected to 
this medicine were affected. Amer. Jour, of Med. Scien. for May, 1832. 

1 Mr. Plumbe says that a fluid readily escapes if these wheals be punctured by 
a sharp instrument, (p. 272.) 



448 OF NETTLE RASH. 

of urticaria, others, erythema, or roseola. Strawberries some- 
times give rise to urticaria; we know a lady who never fails to 
have it after eating of this fruit. 

1729. This is a very troublesome complaint, in consequence 
of the excessive itching which always attends it. It is almost 
always accompanied by sickness of stomach, headache, giddiness, 
and great susceptibility to become chilly upon the slightest ex- 
posure of any portion of the body. The fever which attends 
may be of greater or less violence, but almost always observing 
an evening exacerbation ; at which time all the symptoms are 
increased, and especially the itching. The wheals which appear 
upon the skin are sometimes very extensively spread over the 
body ; and at others confined to certain portions of it, especially 
upon the inner surface of the fore arms, and inside of the thighs. 

1730. From the surface of the wheals there issues an acrid 
serum, or lymph, which serves to perpetuate or renew the trou- 
blesome itching ; and such is the disposition of the skin, while 
labouring under this affection, that you may at pleasure, if the 
fever be considerable, produce a continual eruption, by drawing 
the nail forcibly over the skin, at almost any portion of it. 

1731. This eruption sometimes disappears as suddenly as it 
had showed itself; and when this is the case, serious consequences 
have sometimes resulted, though this disease is but very rare- 
ly fatal. We but once have witnessed danger from the retro- 
cession of the eruption. In this case, the patient had had pre- 
viously several attacks of an intermittent, from which she had 
been relieved each time by the sulphate of quinine. Her health 
appeared to be rapidly mending for sometime, and she had near- 
ly acquired her wonted strength ; when very early one morning 
she was attacked with urticaria, to which she had been occasion- 
ally liable. 

1732. Soon after it had made its appearance she became ex- 
tremely sick, and vomited very freely : she complained of a se- 
vere pain in the head, which was quickly followed by delirium. 
At this time we saw her : besides the symptoms just named, we 
found her extremely restless, throwing herself into a variety 
of positions, as if unable to keep quiet for a moment. The face 
was cadaverous, and evinced much uneasiness ; her intellect was 
not sufficiently collected to give us any rational answer to our 
questions. The extremities were cold, the pulse nearly extinct, 
and the breathing very laborious — in a word, her situation was 
truly alarming. 

1733. Hot applications were made to the feet and legs ; a very 
large sinapism was applied to the region of the stomach ; and 
ten grains of the carbonate of ammonia were ordered every hour, 
together with a spoonful of hot brandy toddy every few minutes. 

1734. The parts of the body from which the eruption had dis- 



OF NETTLE RASH. 449 

appeared, exhibited a mottled livid hue ; other portions of the 
skin were "goose-fleshed," to a great degree. The bowels were 
spontaneously opened, at the time the puking took place, and she 
passed a large quantity of urine. 

1735. We saw our patient after an interval of two hours, and 
found her in rather a more favourable situation, but very far 
from being relieved. The legs and feet were a little warmer, 
but the mustard had scarcely acted upon the skin. The volatile 
alkali and brandy toddy sat well on her stomach; the delirium 
somewhat abated, and the whole skin looked more natural. The 
remedies were ordered to be continued. 

1736. At the end of two more hours we again visited our pa- 
tient, and now found her much amended — that is, the warmth of 
the body greater, and more natural; the delirium and jactitation 
less; the pulse more open; the countenance more natural, and 
less distressed, but no return of the eruption. Remedies were 
ordered to be continued. 

1737. In the evening, upon our return, we found a pretty plen- 
tiful crop of the eruptive wheals, attended by much itching. 
The warmth of the skin rather above the natural standard; the 
delirium gone ; the inquietude over. The volatile alkali and bran- 
dy were suspended; a liberal dose of magnesia ordered; and a 
little chicken water, from time to time, was allowed. 

1738. On our visit on the following morning, we found our 
patient feeble, but relieved from the eruption, and free from 
fever. She was soon restored to health. 1 

1739. It would be difficult to say what may be the cause of 
idiopathic urticaria: be this what it may, the force of the disease 
is chiefly spent upon the cutaneous system ; but with which the 
stomach is sure to sympathize; or the stomach may be the seat 
of the affection, and the skin sympathize with it. It some- 
times becomes chronic; and we have known several young people 
liable several times in the year to returns of it, without any 
evident exciting cause. 

1740. This disease, however, is much more frequently a 
sympathetic affection, and arising sometimes from difficult den- 
tition, and at other times from some offensive substance taken 
into the stomach; this is especially the case with children, until 
the age of puberty. Acids of every kind seem capable of pro- 
ducing it — hence the frequency of its appearance after crude 
fruit, cucumbers, young cabbage, lemonade, when the body is 
heated, &c. 

1741. The plan of treating this complaint is in conformity to 
the condition of the stomach ; for whether this disease be idio- 
pathic or symptomatic, the stomach is sure to possess great acidity 

1 Though professedly treating of the diseases of children, we thought the case 
just related might not be uninteresting, notwithstanding it occurred in au adult- 

29 



450 OF NETTLE RASH. 

— to destroy this, is essential both to its alleviation and cure. 
Magnesia should, therefore, be freely prescribed; lime-water 
and milk should also be given, particularly when the eruption 
has continued several days. A milk diet should be adhered to ; 
and if no fever be present, chicken water and beef tea may be 
indulged in. 

1742. It is common in this disease to give saline purges; but 
this is decidedly injurious — there is no purgative so certain or 
proper as magnesia, or magnesia and rhubarb. It is also com- 
mon to permit the patient to take lemonade; but this is still 
worse; plain water, or toast water not too cold, are the best drinks. 
Solid food should be avoided, as should damp places, or streams 
of cold air. 

1743. To relieve the excessive itching, the patient should be 
liberally dusted with well toasted rye or wheat flour, and resist 
as much as possible the desire of scratching ; instead of which, 
let the part be well rubbed with a handful of flour, and much 
relief will be experienced. 

1744. In the chronic form of this complaint, we have found a 
persevering use of small doses of Fowler's mineral solution to 
have succeeded in every case in which we have hitherto tried it. 

1745. A very interesting case of chronic urticaria is related 
by Cazenave. " In the Hospital of St. Louis, in a patient of 
Mr. Biett's wards, we have seen it accompanying a quotidian 
intermitting fever, and after having lasted for four years, finally 
induce swellings and great distentions, ecchymoses, ruptures, 
and ulcerations. In many paroxysms it was accompanied with 
a general tumefaction, sometimes to such a degree that the pa- 
tient was nearly suffocated; his respiration was hurried, the 
movement of the thorax very slight, the neck swelled, the face 
puffed up and of a violet colour, the pulsations of the heart inter- 
mitting, and at times scarcely perceptible; and death, which ap- 
peared imminent, only prevented by large bleedings. The pa- 
tient, who had passed through several hospitals, and in which 
every means of cure had failed, was at last restored to health 
by the use of Fowler's solution." 1 

1746. We believe we were the first to recommend Fowler's so- 
lution, for the cure of chronic urticaria. Children of from seven 
to fourteen years old, may take four drops every morning, noon 
and evening, in sugar and water; or, should this sicken, give 
but three. 

1 Pract. Syn. of Cut. Dis. Trans, p. 65. 



OF BURNS. 451 



CHAPTER XXXVIL 



OF BURNS. 



1747. Accidents from fire, or hot water, are so frequent arid 
so sudden in their occurrence, and so dangerous, oftentimes, in 
their consequences, that it becomes important that almost every 
one should have a knowledge of the modes of treating them. 

1748. The extent of such accidents must necessarily be various ; 
consequently, all cases of burns need not be treated precisely in 
the same manner. A burn may consist simply of inflammation ; 
or it may be accompanied by vesications ; or the mischief may 
be still greater, and the part may be killed. 

1749. The great anxiety, when this accident happens, is to 
know what should be first applied. Authors differ widely in 
their opinions upon this point; and opposite remedies in their 
turn are proposed and had recourse to. We shall not enter into 
the disputes upon these points, but shall simply relate what we 
ourselves have found to answer best; and only name some of the 
other remedies, of which we have no experience. 

1750. When a part is merely inflamed, we have found the 
steady application of cold whisky, brandy, alcohol, and even water, 
not only relieve the immediate pain, but sometimes quickly re- 
move the inflammation, especially if it be not extensive. If the 
inflamed portion of skin be considerable, the same plan may be 
pursued; but the relief will not be so sudden, though it may, 
eventually, be as certain. Wrapping the part in cotton is highly 
recommended, but we cannot speak of it from experience. 

1751. If vesications attend, we almost always apply the spirit 
of turpentine, a little warmed, to the part, and protect it from 
the air as quickly as possible, if the wound be considerable; 
and, also, that the turpentine should not be applied to the sound 
skin. Should much pain attend, we give a suitable dose of lauda- 
num. We almost always allow the first dressings to remain for 
twelve hours ; and when we re-open the sore, we take care it shall 
not be exposed to a current of air, or a cold atmosphere. Our 
second dressing consists of the basilicon ointment, according to 
the recommendation of the late Dr. Physick. 

1752. We are in the constant habit of opening the vesications 
by the point of a needle, before we apply the ointment. This 
kind of dressing is continued as long as the peculiar inflamma- 
tion of a burn continues ; or, as the common people express it, 
until the fire is out. Should the discharge now become too abun- 
dant, (a very common occurrence, especially if the surface be 
large,) we use the cerate of Turner, or the simple cerate, in 
which a quantity of prepared chalk is incorporated. 



452 OF BURNS. 

1758. Should the burn be deep, and of course the part killed, 
the basilicon is the best application until the parts begin to show- 
signs of separation. But should the parts immediately round 
the injured part be much inflamed, we are in the constant habit 
of using the bread and milk poultice, until it subside. When 
the inflammation is reduced to a healthy degree, we return to the 
basilicon, or to the cerate, until the parts slough out. After this 
has taken place, we either use Turner's cerate, or the basilicon, 
or simple cerate, as the wound may seem to require. We use 
the first where the discharge is too abundant; the second, where 
it is deficient ; and the third, where the suppurating process is 
going on kindly. 1 

1754. In extensive burns, the patient almost always complains 
of a sensation of cold. When this is the case, a free dose of 
laudanum should be given, and he should be placed in an atmo- 
sphere of a moderate temperature. The wound should be opened 
only when necessary. Should much reaction take place, all sti- 
mulating substances, as liquor, animal food, or broths, should be 
withheld ; and in some few instances even bleeding and purging 
are necessary. 

1755. The consequences to be apprehended, or, in other words, 
the prognosis of burns, are sometimes extremely difficult to pro- 
nounce — for they do not always endanger in proportion to their 
extent, yet they do as a general rule. 2 We once saw death in a 
very few hours follow a scald over the region of the stomach. 
The wound was not more than four inches square; the whole of 
the cuticle was removed in taking off the clothes. The child 
made no complaint; on the contrary, soon fell into a sleep from 
which it did not properly awake before it died. A remarkable 
circumstance attended this wound ; it appeared to heal over its 
whole extent an hour or two before death. 3 

1756. Nor is the pain in proportion to the injured surface; on 
the contrary, small burns sometimes give more pain than large 
ones; owing, doubtless, to the more or less destruction of the 
vital principle in the parts affected. My friend, the late Dr. 

T The raw cotton is extremely useful in burns, when not too extensive; the 
raw cotton must be carded, then laid over the burnt surface, and this is left on 
until it heals up: it requires no renewal. 

9 " The unqualified statement that constitutional irritation is in proportion to 
the extent of surface destroyed, or the depth to which the destroying agent has 
penetrated, would be incorrect: such a statement would apply generally, if not 
universally, after the lapse of three or four days from the injury, or, in other 
words, to the after stages of the process; but it is unquestionable, that the situa- 
tion of the injury is, as regards the first days, of greater importance — burns upon 
the neck, chest and abdomen, exclusively, proving oftener fatal by direct irrita- 
tion." — Travers on Constitutional Irritation, p. 76. 

s "Where the cutis is charred and killed, the constitutional sympathy is less 
than where the cuticle, ravelled up into folds like wetted paper, leaves the cutis 
bare; and for a similar reason, vesications, however large or numerous, excite less 
irritation than the state last mentioned." — Ibid. p. 76. 



OF BURNS. 453 

Physick and myself, witnessed a remarkable case of this kind, 
in a young lad, who had fallen up to his chin into a soap-boiler's 
caldron. He was quickly taken out, but complained of no pain 
whatever. He died in a few hours after the accident. 

1757. When burns become extremely painful soon after they 
are inflicted, we believe nothing affords such immediate relief as 
cold. This may be applied by means of a bladder nearly filled 
with water, laid upon the part — -it is sometimes useful to add ice 
to it; or ice may be applied over the dressings, agreeably to the 
recommendation of Sir James Earle. 1 

1758. Burns have almost always this peculiarity in healing; 
namely, they most rapidly shoot up a fungus; nor is this easy to 
subdue, even by active caustics, which we are almost always 
obliged to use. There is little or no sensibility in this fungus; 
when it is abundant, we have often applied caustic to such sur- 
faces, without the patient expressing the least uneasiness. When 
it is more moderate in quantity it is generally more sensible. 

1759. It may be proper to mention that we have seen great 
error committed in the application of caustic, by its being spread 
over the whole fungous surface. This, we believe, is never ne- 
cessary; for the healing proceeds pretty constantly from the 
margin of the wound; consequently it is only necessary to sup- 
press its excess immediately at the edges. Dry lint, where 
compression can be easily made, is very useful in removing this 
superabundant product. But the lunar caustic is the least irri- 
tating and most certain of all the escharotics we have employed, 
if we except the burnt alum. In a case where a large exposed 
surface was filled with a feeble jelly-like fungus, we sifted over 
its whole extent the burnt alum almost daily, with the most 
marked and prompt advantage. This application did not appear 
to give the slightest pain, though we had anticipated a very dif- 
ferent result. 

1760. When burns are healing, great pains should be taken 
that no two parts that are naturally separate should come in 
contact, lest they adhere permanently. On this account, when 
the hands or feet are the seats of the accident, the fingers and 
toes should be kept separate, by well-regulated dressings. Splints 
and bandages may also be necessary to prevent coalescence, or 
contractions. 

1 See American Journal of Medical Sciences, for August, 1833, for Mr. Holt's 
account of the use of Chloride of Soda in burns, scalds, and black eyes. 



454 OF PROLAPSUS ANI 



CHAPTER XXXVIII. 

OF PROLAPSUS ANI. 

1761. This is a very troublesome complaint, where the habit 
of descending is of long standing. It always excites a great deal 
of solicitude for the event, though the disorder cannot be con- 
sidered as dangerous. 

1762. As the inner coat of the rectum is looser and longer 
than the external, it is frequently made to descend by whatever 
will excite a straining or tenesmus — hence the frequency of this 
accident after bowel complaints, especially dysentery. The 
worms called ascarides; (1634) a stone in the bladder; over 
purging; long-continued costiveness, &c, will sometimes produce 
this complaint. 

1763. It will descend to various lengths ; from half an inch 
to several inches; and will very often, in the recent state of the 
disease, return of itself for a time. But this is of short dura- 
tion ; for repeated descents for a few days will generally confirm 
the complaint, and its falling will soon become habitual. When 
it is down, the child suffers considerable pain, especially if it be 
not soon returned; as the sphincter ani acts as a kind of liga- 
ture upon the prolapsed gut. If thus constricted, it soon swells, 
and inflames; and sometimes the stricture is so confirmed as to 
prevent a free return of the venal blood of the part; in conse- 
quence of which it soon becomes livid, or even black, and as- 
sumes an appearance really menacing. 

1764. To prevent this, care should be taken that the gut be 
returned as quickly after its descent as may be possible; espe- 
cially where it is from time to time threatened with this kind of 
strangulation. To insure the return of the gut, after it has pro- 
lapsed, as soon as practicable, the mother should be instructed 
in the method of reducing it, that no time may be unnecessarily 
lost after its escape. The method of doing this is extremely 
simple, and equally easy in recent cases; but in the chronic af- 
fection it is sometimes very difficult to accomplish. 

1765. For the purpose of reducing the prolapsed bowel, the 
child must be laid across the lap, with its head a little lower than 
the hips. The part must then be lubricated with sweet oil, or 
fine hog's lard; a piece of fine linen may be laid over the part; 
then commence the attempt at restoring it, by making a gentle 
but continued pressure in such direction as shall tend to return 
the gut within the sphincter ani. When you have diminished 
the distended part, by forcing a portion of blood from it by the 



OF PROLAPSUS ANI. 455 

pressure made by the finger, the gut must be urged upward, and 
a little backward, until it retire within the verge of the anus. 

1766. Sometimes this operation succeeds best by placing the 
point of the fore-finger against a portion of the prolapsed gut, 
and carrying that portion immediately forward, until it pass the 
sphincter, or the constricting part. After this has passed, an- 
other and another portion is carried in the same manner, until 
all is restored. This method has never failed with us, when the 
prolapsed part has not been considerable ; but it may not suc- 
ceed when a large portion is down. In this case, a steady pres- 
sure, as above directed, (1765,) is the only one we know to be 
useful, for it requires some patience for the pressure so to re- 
duce the swollen part, that it may repass the sphincter ani. 

1767. Indeed, it sometimes becomes so enlarged by hanging 
down, that it would be in vain to attempt the replacement, until 
the bulk of tumour was reduced by proper applications, and ma- 
nagement. For this purpose the child should be kept in a hori- 
zontal position upon its back, with its knees drawn up, and the 
hips raised higher than the head. The part itself should remain 
exposed to the air, 1 but occasionally moistening it with lead- 
water of a proper strength; for on this much depends. 3 

1768. Dr. Underwood declares, (Vol. II. p. 54,) that "should 
such a case occur in children, as it frequently does in adults, in 
which the bowel may not be easily returned on account of su- 
pervening tumour and inflammation, the stricture will never fail 
to yield to an injection of cold water with a few drops of aq. 
lithargyri acetati, 3 with five or ten drops of the tinct. opii. An 
hour or two after such injection has been thrown up, the pro- 
lapsed intestine, though perfectly black as well as swollen, will 
be found to retire of itself." 

1769. In cases, however, of prolapsus ani, the great object is 
to prevent a recurrence of its dropping — for this purpose, the 
plan of the late Dr. Physick is highly important, as we have 
more than once tested by experience. He directs, 1st, that the 
patient should live altogether upon rye mush sweetened with 
molasses, or brown sugar. By this diet the faeces become very 

1 If the weather be cold, the child should be protected by a sufficient quantity 
of covering, though the part itself should be left free. 

•* The following formula for the lead-water is the one we are in the habit of em- 
ploying:— 

I£. Sacch. Saturn. J}i. 
Aq. Font. g vij . 

f. Sol. 
* The following form may be used for this prescription, for a child from three 
to five years old : — 

R. Sacch. Saturn. gr. v. 

Tinct. Thebaic, gut. x. vel. xv. 
Aq. Font. frig. Jj. 

M. f. enem. 



456 OP THE WHITLOW. 

soft, and, of course, can be readily expelled, without much effort 
of the child for this purpose; consequently, the risk of the gut 
coming out is diminished. 2dly. That the child should be made 
to pass its evacuations while standing; by this means the habit 
of straining is interrupted, and the bowel permitted to retain its 
situation. 

1770. The child should sit upon a hard-bottomed chair with- 
out arms; and it should be of such a height as not to allow the 
feet to touch the floor. 

1771. It will be proper, however, to observe, that as this af- 
fection may have a number of causes, any attempt for its relief 
will be totally useless, until the complaint producing it be re- 
moved; therefore in all such cases as do not depend merely 
upon habit, attention should be first directed to its remote 



CHAPTER XXXIX. 



OF THE WHITLOW. 



1772. The extremities of the fingers are liable to a very pain- 
ful inflammation, termed whitlow; which almost always termi- 
nates in suppuration. It is commonly divided into four species, 
which, perhaps, merely differ in degree. 

1773. The first species is the mildest; and locates itself at 
the side or root of the nail. In this species the inflammation 
seems to penetrate no deeper than the true skin; and when it 
terminates in suppuration, the matter is confined immediately 
below the cuticle. Should the matter find its way beneath the 
nail, the patient has to endure a great deal of pain from its con- 
finement in so unyielding a part. 

1774. In the second species, the inflammation penetrates be- 
low the true skin, near the extremity of the finger. It creates 
much pain, especially in very young people; it eventually sup- 
purates ; but it requires a good deal of time before the matter 
discharges itself. 

1775. In the third species, the inflammation is seated within 
the theca which covers the flexor tendons. When suppuration 
takes place in this species, the matter finds great difficulty in 
passing to the surface of the skin, in consequence of which it is 
found to pass along the sheaths of tendons, sometimes even to 
the wrist. 

1 See Amer. Jour. Med. Scien., August, 1833, p. 530, for Dupuytren's method of 
treatment. 



OF THE WHITLOW. 457 

1776. In the fourth species, the periosteum is the seat of the 
inflammation ; and even the bone itself sometimes becomes in- 
flamed. But in this case, the inflammation and suppuration are 
more limited than in the last species. 

1777. In both the third and fourth species, the pain is ex- 
treme ; and the inflammation sometimes runs so high as to swell 
both the hand and arm. Much fever is sometimes excited; and 
we have known even delirium to attend. 

1778. This disease is frequently produced by punctures, or 
other injuries of the like kind — we have known it several times 
produced by the sharp fin of a fish, and especially the cat-fish. 

1779. The different species will require something different in 
the treatment. It rarely fails to suppurate ; and we still more 
rarely have it in our power to prevent it. Several plans, however, 
have been proposed for this purpose; some of which are said to 
have been attended with success — such as holding the finger in 
very warm water, vinegar, or ley, poultices of the white of an 
egg and honey; of ley, of brown soap, &c. 

1780. As this complaint almost always runs on to suppuration, 
the sooner this is promoted the better; especially in the first two 
species. For this purpose, we believe there is nothing better 
than the good old fashioned bread and milk poultice. This must 
be repeated every few hours, until the matter forms. When 
this happens, it should be discharged, by opening the abscess as 
soon as it becomes evident. The wound may be dressed with 
simple cerate. 

1781. In the third and fourth species, much more trouble and 
pain are experienced. Blisters are said to have relieved this 
deep-seated inflammation: we believe this has happened, but it 
has been rarely. Much patience must be exercised, and suffer- 
ing endured, before the matter in these cases will find its way 
to the surface; and sometimes much mischief is done the parts 
below and around it, before this happens. The bone and ten- 
dons are killed, and the usefulness of the hand is sometimes de- 
stroyed, by permitting this complaint to run its course. M. 
Serre D'Alais highly extols the application of mercurial oint- 
ment in paronychia. The finger is to be rubbed with it every 
fifteen minutes, and then enveloped in it by means of a soft rag. 
— Amer. Jour, of Med. Sci. for Nov. 1834. We have tried the 
plan of cure in a very painful paronychia with decided advan- 
tage. 

1782. On this account, it is considered best to cut down to 
the part, in the direction of the finger, before suppuration has 
taken place, or as quickly after as possible ; and not to wait for 
the tedious and painful operation of spontaneous opening. By 
this plan immediate relief is always experienced ; for if suppu- 
ration has taken place, a wound which will quickly heal is sub- 



458 OF DISCHARGES FROM THE VAGINA. 

stituted for an untoward inflammation, which would eventually 
terminate in it. If matter has formed, it will now be discharged, 
and the parts will readily heal, by very common attention — the 
wound may be poulticed for two or three days after the incision 
has been made, and then dressed with simple cerate. If the 
bone or tendon has sustained injury, the progress of the cure 
will be very slow. Bone may exfoliate, or tendon slough. The 
portions of the bone should be removed by forceps, when loose, 
and the protruding tendon cut off, as it may appear. If proud 
flesh shoot up through the external opening, it must be removed 
by caustic, or the opening enlarged. 



CHAPTER XL. 



OF THE DISCHARGES FROM THE VAGINA. 

1783. We occasionally find that very young children have a 
discharge from within the labia, of a thin acrid kind, or of a puru- 
lent appearance. When this occurs in very young subjects, it 
always proceeds from a neglect of cleanly attention to these 
parts; either by withholding a frequent use of lukewarm water, 
or permitting the child to remain too long wet. In either case 
the difficulty is easily removed, by frequent washing, and the 
occasional use of weak lead-water. (See note to par. 1768.) 

1784. Children, however, more advanced in age, have also 
discharges of a purulent character, that seem to arise from a 
morbid action of the mucous membrane of the vagina or labia. 
This frequently shows itself about the fifth year, and may con- 
tinue, if neglected, to almost any period. Parents, therefore, 
cannot be too much upon the alert, when this discharge is dis- 
covered on their children ; nor too early in the application of 
suitable remedies for its removal. It is in a great measure owing 
to this neglect, that fluor albus, or whites, become so common, 
and of such difficult management, in adult age. 

1785. If not interrupted in the beginning of its career, it is 
apt to continue until the period of puberty, over the phenomena 
of which it but too often exerts an unfriendly influence. 1 

1786. The cure of this complaint must be attempted by a 
strict attention to cleanliness; having the parts washed three or 
four times a day with warm water; and each of these washings 
to be followed by another, of warm lead-water. Should the 

1 Treatise on the Diseases of Females, Chapter on Deranged Menstruation, by 
the author. 



OF SCURFINESS OF THE HEAD. 459 

parts be inflamed, or excoriated, they should be covered from 
time to time with very fresh lard. If the bowels be costive, 
small doses of magnesia should be given daily, so as to keep them 
a little free. Should they not be costive, or inclined to lax, the 
prepared chalk mixed with magnesia, or alone, according to 
either of these states, may be used. The diet should be strictly 
of milk: rice, or Indian mush, may be taken with the milk, or 
bread simply, if preferred. 

1787. Should these fail to interrupt the discharge, we must 
have recourse to some other remedies. The most certain that 
we have found, is the tincture of cantharides in proper doses. 1 
But should a prejudice be entertained against it, or if it fail, 
small doses of the balsam copaiva may be given ; 2 and a plaster 
of Burgundy pitch should be applied to the back, very low down. 
But care should be taken that it is not allowed to remain long 
after it excites considerable itching; as it may produce too much 
irritation. 



CHAPTER XLI. 



OF SCURFINESS OF THE HEAD. 



1788. Children, within the month, contract a dark-coloured 
scurf; especially from the top of the forehead to the back part 
of the head. It usually commences near the anterior fontanelle, 
or opening of the head, and gradually spreads itself, until it covers 
the whole crown. It acquires a considerable thickness, and will 
sometimes be thrown off in large flakes, or be frequently removed 
by rubbing, in consequence of its itching. 

1789. At times this itching is so severe as very much to in- 
terrupt the comfort of the child. The scurf is occasionally very 
offensive ; its smell resembling that of sour curd. If the part be 
closely viewed, it will frequently be found covered with a vast 
number of small pustules, which, after awhile, pour out a thin 
acrid lymph ; and this becoming dry, forms a crust. Upon the 
removal of the crust by any kind of violence, the skin underneath 

1 It is proper to begin with small doses of this medicine, say, five drops, every 
morning, noon, and evening, in a little sugar and water. After this quantity has 
been taken a few days, the dose may be increased a drop or two; and it may be 
Thus augmented to ten or twelve drops, or even more, if necessary. But if any 
irritation of bladder show itself, it must be laid aside until it cease. Should it 
be required after this by a continuation of the discharge, it may be commenced 
again, and proceeded with, as just mentioned. 

a From eight to ten drops of this balsam may be given three or four times a 
day, dropped on some brown sugar, and washed down by a little warm milk. 



460 OF SCURFINESS OF THE HEAD. 

is often found inflamed. The removed crust, however, will quickly 
be replaced, by the exposed surface pouring out a quantity of 
fresh lymph, which quickly hardens into a new one. 

1790. The formation of this crust is, for the most part, owing 
to neglect, and this neglect arises from prejudice ; it being sup- 
posed by many that it would be wrong to remove it ; and thus 
it is permitted to accumulate in unsightly and injurious quanti- 
ties. 

1791. As this complaint (if it may be so termed in its com- 
mencement) originates from a neglect of cleanliness, it should be 
removed, after it has occurred, by suitable means, or be pre- 
vented by proper precautions. If it be neglected, this now in- 
offensive scurf may degenerate into a real disease, and require 
time for its removal. The proper plan of management will con- 
sist, 1st, in its prevention; and, 2dly, in its cure after it has 
taken place. 

1792. 1st. To prevent this, all that is necessary is to have the 
head of the child regularly washed every morning with water, or 
with a little fine soap and water; to have it well wiped and dried 
with a fine cloth ; and then brushed with a brush of sufficient 
stiffness to penetrate to the skin ; and not to have the caps of 
the child of too thick a material. 

1793. 2dly. After the incrustation is formed, it should be 
rubbed with sweet oil, or fine lard, at night, and washed off with 
a strong solution of borax and water — that is, in the proportion 
of an ounce of the borax to three half pints of boiling water. 

1794. The borax water should be a little warmed before the 
head is washed with it; and this repeated daily, until the scurf 
is removed. After the scurf is removed, the part should be 
washed daily for a few days with the solution of borax, which 
will effectually prevent its re-formation. 

1795. Should, however, the skin beneath the scurf be inflamed, 
or yield a purulent discharge, the parts should be rubbed once 
a day with the tar ointment, having first prepared the parts by 
washing, &c, as just directed. 

1796. We have seen this scurf attempted to be removed, by 
simply washing and combing the head. We do not approve of 
this plan; as the fine comb, which is always employed, fre- 
quently produces so much irritation as to increase the disease. 
A brush is the most proper instrument for this purpose, as just 
suggested. 



A TRANSLATION 



THE PRESCRIPTIONS 



Page 250, par, 943. 
Take, Of prepared calomel 3 grains. 

Loaf sugar, 6 grains. 

Mix intimately, and divide into 12 part; 

Page 262, par. 975. 

Take, Prepared chalk, 2 drams. 

Laudanum, 20 drops. 

Oil of caraway, 1 drop. 

White sugar, 2 drams. 

Water, 1 ounce. 

Mix. 



Page 270, par. 1004. 
Take, Calcined magnesia, 12 grains 

Laudanum, 3 drops. 

Loaf sugar, enough to make sweet. 

Water, 1 ounce. 

Mix. 



Page 273, par. 1013. 

Take, Calcined magnesia 20 grains. 

Tincture of asafeetida, 60 drops. 

Laudanum, 20 drops. 

Water, 1 ounce. 

Mix. 



462 TRANSLATION OF THE PRESCRIPTIONS. 

Page 274, note to par. 1016. 

Take, Sulphate of quinine, \\ grain. 

Loaf sugar, \\ dram. 

Water, 1 ounce. 

Dissolve. 



Page 278, par. 1032. 

Take, Prepared calomel, 4 grains. 

Calcined magnesia, 8 grains. 

Mix, and divide into 8 parts. 



Page 279, par. 1034. 

Take, Acetate of zinc, 2 grains. 

Rose water, 2 ounces. 

Dissolve. 



Page 280, par. 1039. 

Take, Blue vitriol, 10 grains. 

Powdered (best) Peruvian 1 ~ n • -• T 

, , v ' > 60 grains, or 1 dram. 

Gum Arabic, do. 

Honey, 2 drams. 

Water, 3 ounces. 

Dissolve and mix. 



Page 294, par. 1108. 

Take, Prepared calomel, 10 grains. 

- — — chalk, 20 grains. 

Mix and divide into 20 parts. 



Page 295, note to par. 1110. 

Take, Prepared calomel, 2 drams. 

Essence of Lemon, 20 drops. 

Common cerate, 1 ounce. 

Mix, 



TRANSLATION OF THE PRESCRIPTIONS, 

Page 356, par. 1378. 
Take, Prepared chalk, 3 drams. 

Laudanum, 20 to 30 drops. 

Oil of cinnamon, 1 drop. 

White sugar, 2 drams. 



463 



Water, 



2 ounces. 
Mix. 



Page 361, par. 1398. 
Take, Prepared calomel, 3 grains. 

chalk, 20 grains. 

Opium, half a grain. 

Mix, and divide into 12 parts. 



Page 371, par. 1433. 

Take, Prepared chalk, or oyster-shells, 1 dram and a half. 

Powdered gum Arabic and loaf 1 , -, , 

° Veach 1 dram, 

sugar, J 

Laudanum, 10 drops. 



Water, 



3 ounces. 
Mix. 



Same page and par. 
Take, Salt of tartar, or soda, 30 grains. 

Gum Arabic and loaf sugar, each 1 dram. 

Tincture of opium or laudanum, 10 drops. 
Water, 3 ounces. 

Mix. 



Page 371, par. 1437. 
Take, Copperas, 2 grains. 

Oil of vitriol, 10 drops. 

1 dram. 
1 ounce. 
Mix. 



bugar, 
Water, 



Page 389, note to par. 1503. 
Take, Tartar emetic, 

Oil of lavender, or essence of lemon, 
Simple cerate. 



1J dram. 
15 drops. 
1 ounce, 
Mix, 



464 TRANSLATION OF THE PRESCRIPTIONS. 

Page 455, note to par. 1767. 
Take, Sugar of lead, 1 scruple. 

Water, (soft,) 8 ounces. 

Make a solution. 



Page 455, note to par. 1768. 
Take, Sugar of lead, 5 grains, 

Laudanum, from 10 to 15 dr. 

Cold water, 1 ounce. 

Mix for an injection. 



GLOSSARY, 



EXPLAINING THE TECHNICAL TERMS USED. 



Abscess, a collection of pus or matter. 

Abdomen, the belly or paunch. 

Abdominal viscera, the contents of the abdomen. 

Abortion, miscarriage. 

Anthelmintics, medicines against worms. 

Antiphlogistic s, such medicines as reduce an inflammatory habit. 

Aphtha, baby's sore mouth. 

Artery, a strong elastic circular tube which carries the blood 

from the heart. 
Axillary, belonging to the arm-pit. 



Cardia, the upper, or left orifice of the stomach. 

Catamenia, the monthly discharge of women. 

Chyle, a white fluid produced by digestion. 

Chyme, the first product of digestion, and from which the chyle 

is separated. 
Clavicle, the collar bone. 
Coagulum, a clot of blood, or of milk. 
Colostrum, the first milk after delivery. 
Colly rium, a wash for the eyes. 
Combustion, burning. 
Congenital, made or formed at birth. 
Connate, born with. 



Diaphragm, a muscle which separates the belly from the chest. 
Dorsal, belonging to the back. 
Duodenum, the first bowel below the stomach. 
Dyspepsia, depraved digestion. 
30 



466 GLOSSARY. 

Enema, or plur. Enemata, injection or injections. 
Excitability, the capacity to be acted upon by stimuli. 
Excitement, the action produced by the application of stimuli. 
Exfoliate, the act of casting off dead bone or scales. 



Farinaceous, mealy. 
Foetal, belonging to a foetus. 
Foetus, a young animal before birth. 



G-angrene, a mortification, or nearly the loss of life of a part. 



Idiopathic, an original affection of a part. 
Iliac Passion, dry belly-ache. 



Leucorrhoea, the whites. 

Liquor Amnii, the water surrounding the foetus. 

Lumbar, belonging to the loins. 



Meconium, the faeces of a foetus. 

Miasm, sing., Miasmata, plur., any fume or effluvia capable of 
producing disease. 



Nausea, sickness at the stomach. 

Nitrogen, one of the constituents of the atmospheric air. 



(Esophagus, the gullet. 

Ophthalmia, an inflammation of the eyes. 

Ovum, an egg. 

Oxygen, the basis of a vital air. 

Oxygenation, acquiring oxygen. 



Pabulum, food. 

Papula, a very small and acuminated elevation of the cuticle, 
with an inflamed base, very seldom containing a fluid, or 
suppurating, and commonly terminating in scurf. 

Pectoral, belonging to the breast. 

Physical, that which relates to natural agents — that which is 
opposed to moral. 



GLOSSARY. . 467 

Physiology, the doctrine which teaches the use and actions of 
living parts. 

Placenta, the after-birth. 

Plethora, fulness of blood. 

Pica, the matter found in abscesses, and other parts after in- 
flammation. 

Pustule, an elevation of the cuticle, with an inflamed base con- 
taining pus. 



Rickets, a disease of the bones. 

Rupture, a protrusion of any of the contents of the belly through 
the parietes of that cavity. 



Sanguiferous system, the blood-vessels, both arteries and veins. 

Scab, a hard substance covering superficial ulcerations, and 
formed by a concretion of the fluid discharged from them. 

Scirrhus, a tumour affecting glands. 

Scrotum, the bag under the penis containing the testicles. 

Scurf, small exfoliations of the cuticle, which occur after slight 
inflammation of the skin, a new cuticle being formed under- 
neath during the exfoliation. 

Secretion, the separation of various fluids, and other matters, 
by glands, from the blood. 

Stigma, a minute red speck in the skin, without any elevation 
of the skin. 

Symptomatic, arising from, or indicative of some other affection. 



Tenesmus, an ineffectual urging to go to stool. 
Tormina, a griping pain. 

Tubercle, a small, hard, superficial tumour, circumscribed and 
permanent, or suppurating partially. 



Umbilicus, the navel. 

Umbilical cord, the cord connecting the child with the mother. 

Umbilical hernia, a protrusion of a bowel at the navel. 

Uterus, the womb. 

Utero-gestation, the term of pregnancy. 



Vesicate, to blister. 
Vesication, blistering. 



468 GLOSSARY. 

Vesicle , a small orbicular elevation of the cuticle, containing 
lymph, which is sometimes clear and colourless, but often 
opaque, and whitish, or pearl- coloured. 



Wheal, a rounded or longitudinal elevation of the cuticle, with 
a white summit, but not permanent ; not containing a fluid, 
nor tending to suppuration. 



INDEX. 



*^*The first numbers refer to the Paragraph, and the latter to the page at 
which the subject commences. 



A. 

Abortion, cause of the facility with which it may be procured 

physical evils resulting from 

moral obligations to the prevention of 

dreadful consequences from repeated 

rules to be observed for prevention of 

produced by a gossip's story 

general rules for the prevention of . 
Appetite, not to be indulged during pregnancy 
Air, of the ..... 

general observations on . 

importance of pure air to children . 
Arguments against the opinion that the imagination has power 

to mark the child in utero .... 
Appeal to the good sense of parturient women . 
Absurd modes of dressing young children . 
Accidental and partial application of cold to be avoided 
Aphthae, or sore mouth of children . 

symptoms ...... 

whether the aphthae pervade the whole alimentary canal 

whether contagious or epidemic 

time of life subject to it 

treatment ...... 



B. 

Beauty in females, cause of early loss of 

Bleeding not to be used without advice of physician 

Dr. Struve's opinion on ... . 

of great importance under judicious direction . 
Buchan's errors in relation to children's dress . 
Belly-band, necessity and utility of 

reasons why it should not be too tight 
Bathing and cleanliness, general observations on 

cold bath, definitions of, and objections to 

warm and tepid bath ..... 

neither warm nor cold bath to be used without the advice 
of a physician ...... 

Dr. Struve's rules for bathing young children . 
Breasts, inflammation and swelling of, in new-born children 

erroneous opinion respecting .... 



Par. 
27 
28 
29 
30 
33 
88 

292 
42 

418 
445 

68 
118 
194 
236 

983 

986 

991 

1001 

1004 



Page 

25 

25 

25 

25 

26 

41 

91 

28 

113 

113 

121 

36 

48 

66 

76 

265 

265 

266 

268 

269 

270 



7 


19 


36 


27 


38 


27 


40 


28 


201 


68 


217 


72 


223 


73 




210 


812 


213 


814 


214 


826 


216 


827 


216 




281 


044 


281 



4T0 



INDEX. 



Breasts, treatment of ... 

Burns ...... 

treatment where the skin is merely inflamed 
where vesications attend 
when healing 
caution lest adhesion take place . 



Cotton, raw, its usefulness in burns 
Consequences of ill-assorted marriages 
Constitution, the best, how perpetuated, 
Constitution, of the 

soundness of, to be considered in marriage contract 

fallacious appearance relative to soundness of 
Conduct to be observed before and during delivery 

during the month .... 
Child-birth rarely dangerous in this country . 
Children always to be suckled by their mothers 

lives may be endangered by selfish nurses . 
Child, rules for washing the . 

general dress, observations on 

to be changed whenever circumstances render it necessary 
Children, new-born and older, physical treatment of 
Crying of infants ..... 
Cause of child crying at birth . 

to a degree salutary . 

causes of . 
Cleanliness and bathing of children 
Colic of infants 

divided into two species 

treatment of each 
Constipation, 

oftentimes produced by laudanum 

treatment of . 
Cholera infantum 

exciting causes 

symptoms 

prognosis 

seat and nature of 

treatment 

in very young children 
regimen during 
removal to country 

prevention, modes for the 
Cynanche tonsillaris, or sore throat 

symptoms of . 

treatment of 

prevention of 
parotidae, or mumps 

symptoms of 

treatment of 
trachealis, or croup 

age subject to its attacks 

mode of attack, and time . 

most dangerous when neglected in forming stage 

Laennec's opinion of its character 



Par. 


Page 


1046 


282 




451 


1750 


451 


1751 


451 


1759 


453 


1760 


453 



1753 

9 

10 

12 
13 
91 

112 
132 
167 

226 
245 

405 
402 
405 
406 



1010 
1012 

1223 
1225 

1403 
1404 
1412 
1415 
1418 
1422 
1440 
1441 
1443 

1507 
1517 
1524 

1526 
1528 

1537 
1540 
1547 
1549 



INDEX. 

Cynanche trachealis, its anatomical character, by Laennec, 

(notef) 

divided into three stages .... 
first stage, or incipient . 
second, or when the disease is formed 
third, or congestive stage 
formation of false membrane 
treatment of the first stage 

second stage 
third stage / 
his account of the false membrane . 
his successful remedies (note 1 ) . 



471 

Par. | Page 
1551 

1563 



1564 
1607 



D. 

Disease, predisposition to . 

dispositions, diseased, do not appear till long after birth 

hereditary, dishonesty of concealing, 

produced by repelled milk .... 

how removed . ..... 

Drinks, stimulating, very injurious 

never used with impunity 
Diet of mother during the month, general rules for 
Diapers always to be changed when wet, &c. 
Dress of the child ..... 

how to be regulated to avoid the use of pins 
within the month, general rules for . . 

from weaning until puberty .... 

form of garments ..... 

quantity and quality of clothing .... 

Duties, social, best accomplished when the body is healthy and 
full grown . . . . 

of the mother after the month .... 

mother should learn to wash and dress infant 
food proper for mother, and rules as to diet 
danger of attempting to remedy partial diminution of milk 
failure of milk more frequently from an over than under 
quantity of food ..... 

remedies contributing to improvement of the milk 
Diseases of children. Book II. ... 

Dentition ....... 

gives rise to a variety of sympathetic affections 
states of the system when attended with danger 
morbid sympathies connected with . 
symptoms attendant on . 
lancing the gums, directions for 
co-operative treatment 

advantages arising from cutting the gum, &c. 
diseases arising from 

eruptions .... 

crusta lactea, or milky scall . 
tooth rashes 

strophulus confertus. Tooth rash 
intertinctus. Red Gum 
albidus. White Gum 
volaticus 
candidus . 



14 

15 

144 

147 

80 

83 

292 

236 

193 

239 

330 



11 

274 

277 
280 

281 
290 



1049 
1055 
1059 
1063 
1068 
1070 
1075 



472 INDEX. 

Diabetes of children . 

Diarrhoea of children .... 

feculent ...... 

bilious . 

mucous ...... 

chylous ..... 

lienteric ...... 

other varieties .... 

chronic form ..... 

treatment of chronic diarrhoea, or weaning brash 



E. 



Evils of precocious marriages 

Europe, dread of hereditary diseases 

Error relative to extra food for pregnant women. &c. 

Exercise, to the extent of causing fatigue, to be avoided 

Exceptions to the rule relative to suckling, very few 

Exposure and hardening of children . 

general observations 

danger of exposing infants to cold and damp 

anecdotes respecting 

danger of too great delicacy of treatment 
Exercise for young children 

carrying in the arms .... 

walking ..... 

general observations on other modes 

riding in a carriage .... 

on horseback .... 

games of various kinds 

dumb-bells ..... 

Erysipelas ..... 

time of attack and part of the body affected 

stages of the disease 

treatment ...... 

Ear, abscess within the . 



Females may be ineligible for marriage from various causes 
Fulness of the head in pregnancy, how to be avoided 
Foetus, membranes and weight of 
Food, dictates of nature relative to quantity of 

proper for pregnant women . 

causes which may render it improper for the mother to nurse 

proper for children after first dentition and weaning 

care to be taken that permanent dislikes to certain food are 
not formed ...... 

are there substances in common use absolutely hurtful to 
children ...... 

fruit in general ..... 

fresh fruit . . . 

dried fruit ...... 

Feeding the child in the month .... 

substitute for mother's milk . 

injurious effects of pap during the month 

mode for preparing substitute for mother's milk 



Par. 



1330 



20 

40 

111 

136 

460 

464 
469 
478 

761 

778 
785 
786 
792 



954 
957 
959 



23 
39 

44 



489 



720 



734 
735 

758 
247 
248 
249 
252 



INDEX 



473 



Feeding, 

general rules as regards . 
Feelings, distressing, caused to a mother by recollection of her 
neglect ...... 

Flannel absolutely necessary in winter or in cold weather 

error relative to dirty .... 

protection afforded by, in variable weather 

may be improper for various reasons 

belly-band should be of 

fashion ...... 

danger of exposure of arms of children 



Fire 



, great care to be taken to prevent accidents from to 
children ...... 



Galen's opinion of the power of the imagination, &c. . 
Gossiping stories injurious to pregnant women 

productive of abortion . 

Glass not to be introduced into the nursery, if possible 



H. 

Hereditary complaints, tendency to, to be investigated 
Health, immediate state of, defined 

why disregarded by parties concerned 
Habits, bad, objections to marriage 

Hunter, Dr., experiments and conclusions on the power of ima 
gination ..... 

singular case related, and left unaccounted for by 
Highly injurious effects of stimulating drinks . 
Hydrocele ..... 

diagnosis ..... 

treatment . . . 

Hernia, umbilical .... 

nurse not to be blamed for this complaint 

to be attended to as early as possible 

treatment .... 

inguinal ..... 

symptoms .... 

Dr. Underwood's opinion erroneous 

Dr. Physick's plan of treatment 
Hip joint, abscess of 

not perceived or attended to early 

mode of detection, and symptoms 

mode of treatment 

curved splint .... 



I. 

Instances of longevity ..... 

Intoxication after marriage, unfortunate frequency of . 

Injury to child in utero from causes insufficient to produce abor- 
tion ....... 

Imagination has no influence on the unborn child . 
origin of the belief in the powers of 



Par. 

339 

85 
208 
209 
211 
213 
216 

458 

387 



61 

87 

88 

390 



14 

18 
19 
21 

72 

74 
80 

1171 
1172 

1175 
1178 
1179 

1181 
1182 
1183 

1185 
1187 
1189 
1193 



9 
22 



34 
55 
56 



474 



INDEX 



Imagination, 

prejudices on the subject of, difficult to remove 

general opinion among the ancients as to its power 
Important duties of a pregnant woman 
Indiscriminate use of laudanum and the lancet reprehended 
Intention, the test of criminality, in cases of neglect 
Is every woman capable of nursing? 
Injuries, physical, caused by deficiency of milk 

from bad milk ..... 

from want of care, &c. .... 

from selfishness of nurses .... 

from propagation of an occult or active disease 
Jaundice ...... 

symptoms, &c. 

whether communicable from milk of mother or nurse 

treatment ..... 



L. 

Longing ....... 

Longing ...... 

singular instances of 

disappointment of, not to be dreaded 
Labour, risk of diminished by presence of good medical aid 

commencement of, never to be interfered with . 

arguments against despondency during a first 

general rules to be observed at the period of 
Laudanum, artfully used by selfish nurses . 

detection of a nurse in the clandestine use of 
Laudanum, never to be administered but by mother or some 

trusty person .... 
Labia pudendi, adhesion of, in children 

importance of early attention to 
treatment .... 



M. 

Marriages, too early, not approved of 

judicious, combined with proper physical education, best 
preventive of hereditary diseases 

why not to be long deferred by females . 

why not to be entered into by very young girls 
Modes in which the imagination is supposed to act on the 
foetus ....... 

Marks, certain, may be hereditary 

Milk fever, and artificial condition produced by errors in diet 

Moral injuries caused by nurses 

Materials of children's dresses to be suited to the season . 

Milk posset, how to be made .... 

Molasses posset ...... 

Mother, general rules for conduct after birth of child . 
Milk of mother, general rules respecting . 
Meconium, of the, and management . 

to derive advantage from it, child must be applied to the 
breast early ..... 

purging off the meconium of moment, but drastic purges 
not to be used ..... 



Par. 

59 
60 
84 
114 
138 
149 
155 
156 
159 
161 
170 

932 

939 
942 



46 

51 

48 

52 

108 

113 

116 

317 

164 

166 

511 

1208 
1213 



15 

24 
25 

62 

70 

117 

173 

200 



323 
347 



498 
499 



INDEX. 



475 



Meconium, proper remedies to be used 
observations on 
case of disease from retention of 



N. 

Notions, ridiculous, relative to the power of the mother's imagi 

nation .... 
Nature of the connexion existing between mother and child 
Nipples, cause of sore ..... 
means of preventing soreness of 
injured by compression .... 
how to bring out when imperfect 
Nurses, their selfish tricks exposed 

too much confidence reposed in their judgment 
duties as regards physicians 
Nursing, important rules relative to ... 

partial or artificial .... 

only reasons for .... 
present a choice of means 

1. Means where mother may continue to nurse 
substitute for milk, and mode of giving 
age proper for change of diet, and rules respecting . 
child not to be permitted to sleep at the breast 
use of butter, &c. ..... 

2. Where artificial means must be used exclusively 
feeding from the bottle to be preferred to the spoon, and 

rules ...... 

analysis of milk of different animals 
general rules as to feeding child 
mode of preserving milk in a proper condition 
Rousseau's opinion as regards milk 

3. Means or employment of a wet nurse 
general observations .... 
requisites in a nurse, &c. .... 
mother should assume all duties but that of suckling 
if the child be sent away, to be placed in the country 

Nursing, drinks for a child ..... 
Nursery, of the ...... 

rules for choice of nursery, and plan . 

should be carpeted .... 

mattresses to be preferred to feather beds 

early and late rising, observations on 

cradles, advantages of, and observations on . 

mode of warming ..... 

amusements for children in . 

accidents children are liable to 

ventilation to be strictly attended to, and rules respecting 

children never to be left alone ; or animals to be left with 
them . . . ^ 

rules as to lights ..... 
Nourishment proper for child .... 

milk of mother to be preferred 

child not to be subjected to laws of nursing till six months 
of age ...... 

rules to be followed after six months . 
Needles not to be employed in place of pins . 

cases of serious injury from .... 



Par. 
501 

927 



62 
64 
125 
126 
131 
138 

503 
505 
511 

520 
520 

521 

529 
536 
539 



544 
563 
566 
573 
581 

588 
595 
610 
617 
620 

352 
357 
360 
365 
371 
374 
378 
387 
391 

396 

398 

513 

516 
516 

240 
241 



Page 
137 
252 
252 



476 



INDEX. 



Necessities of new-born children 
Navel-string, bleeding from . 

should be occasionally watched 

causes ..... 

curious case of bleeding from navel-string 

practical cautions 

ulceration, or imperfect healing of 

exhibits three different conditions 

treatment of each . 



0. 



Officiousness of ignorant practitioners and mid wives, injuries 
caused by ..... . 

Observances towards the mother during the month 

great cleanliness to be observed . 

importance of free ventilation . 

how soon a woman may venture abroad with safety after 
confinement . . ... 

importance of proper exercise 

towards child from second dentition to puberty 

eating ...... 

drinking 

sleeping ..... 

exercise ..... 
Ophthalmia ...... 

symptoms and causes 

prevention and treatment 

Dr. Underwood's description unsatisfactory, &c. 

astringent lotions not to be used early . 

treatment ..... 



Period of life at which the body is matured 

not to be precisely fixed by lapse of time 
Pregnancy does not necessarily require the use of the lancet 

appetite for food not to be excessively indulged during 
Period at which the imagination is supposed to act upon the 

fetus undetermined . . . 

Popular error relative to " keeping up the strength ; ' 
Pins, too many used in dressing infants 
Pertussis, or whooping-cough 

symptoms . . . . 

duration of complaint . 

pathology of . . . 

origin ..... 

various writers on, (note) .... 

considered as essentially inflammatory, by Drs. Watt, Des 
ruelles, Laennec, &c. .... 

opinion of Desruelles . 

most severe in infants 

treatment . . 

bleeding in, opposed by Burton and Millar 
absolutely necessary in many instances 

the plans of treatment of Willis, Sydenham, &c. . 

not of opinion it is caused by cerebral inflammation . 



Par. 
416 

1158 
1159 
1160 
1163 

1166 



109 





263 


• 


264 


alter 


266 


• 


270 




851 


. 


865 




866 


• 


874 




1019 




1025 


. 


1027 




1030 




1032 



41 

42 

67 
115 
238 

1448 
1452 
1453 
1454 



1462 
1463 
1460 
1465 
1466 
1467 
1468 
1476 



INDEX. 



477 



Pertussis, or whooping-cough, 

observations as to the determined course of the disease 

danger of opinion that the disease cannot be shortened 

defence of author's mode of treatment against the attack 
of Desruelles 

use of the bark in . 

Sutcliffe's plan in 

change of residence 
Prolapsus ani 

causes 

symptoms 

to prevent constriction 

mode of reduction 

Dr. Underwood's opinion 

prevention, Dr. Physick's plan 



R. 



Reasons why pregnant women should avoid too much exercise 

Remedies which contribute most to the improvement of the 

milk ..... 

Rules to prevent abortion .... 

for conduct during labour . 

after the birth of the child i 

as regards nursing 

dressing child 
to be observed by nurse after weaning child 
Room proper for purposes of a nursery 
Rocking horse as an appendage to a nursery . 
Respiration, want of, &c. in new-born children 

premature tying the cord often injurious to the child 

Mr. Burns' opinion . . 

first object after delivery of child is establishment of respi 
ration ...... 

rules to be observed if there be no pulsation of cord 

where cord pulsates strongly, but child does not cry 
where child is born still from delay in the passages 
bleeding child from the funis .... 

rules for doing this ..... 

the want of, an interesting case 
Retention of urine in children .... 

new-born children often do not pass their urine for some 
time after birth ..... 

interesting case of retention .... 

state of the bladder should always be examined . 
report of nurses not to be relied on 
Rubeola, or measles ..... 

most frequent in winter and spring 

said to be epidemic every seven years 

said to be contagious ..... 

whether the constitution be subject to a second attack 
symptoms ...... 

prognosis . . . . . . 

more generally inflammatory than other eruptive diseases 
treatment . . . . . 

sequelae of measles . . 



Par. Page 



1452 
1485 
1481 
1501 
1495 
1497 
1505 

1762 
1763 
1764 
1765 
1768 
1769 



110 

290 
292 
320 
323 
326 
330 
652 
351 
370 

885 
886 

892 

894 
896 
897 
898 
900 
904 



979 
979 
981 
981 

1695 
1696 
1697 
1698 
1699 
1707 
1710 
1712 
1725 



INDEX. 



S. 

Safety and comfort in pregnancy promoted by cheerfulness 
Sore nipples to be avoided by applying the child early 
evils resulting from .... 
Suckling considered as a duty .... 

neglect of, accounted, criminal 

as a pleasure ...... 

as it may affect the mother's health 

as it may affect the child 

if there be a failure in quantity of milk, not to attempt to 
increase it by stimulants .... 

milk of mother fittest nourishment for child 

child not to be permitted to sleep at the breast 

if wet nurses be employed, mother to attend to all duties 
but that of suckling ..... 
Stockings recommended, and objections against 
Shoes recommended ..... 

objections to, considered .... 
Sleep of new-born children . . . . . 

not to be permitted to sleep always in a quiet room 
Syncope, or fainting of new-born children . 

immediately after birth .... 

causes of ..... 

treatment ...... 

children at full period more likely to survive the attack 

cases of recovery of six months 5 children . 

causes which may induce it in nine months' children 

mode of treatment ..... 

11 fits " of new-born children 

case of " fits " 

Dr. Underwood's plan . 
Scarlatina, or scarlet fever 

has been divided into three forms 

definitions of these 

are identical, but different stages of the disease 

symptoms ..... 

state of pulse in different stages 

eruption 

whether it be contagious 

prognosis . 

treatment of simple form 
of other forms 

sequelae of the disease . 
Scurfiness of the head . 

symptoms of the head . 

owing oftentimes to neglect 

treatment 

comb should not be used . 



Par. Page 



77 
103 
120 
134 
137 
142 
144 
151 

347 
513 
536 

610 
230 
231 
232 
411 
413 

906 
907 
908 
910 
910 
913 
914 
916 
919 
925 

1676 
1677 
1677 
1679 
1682 
1683 
1685 
1686 
1687 
1691 
1693 

1789 
1790 
1792 
1796 



r. 



Time of life best suited for marriage 
Temper, evils to pregnant women from indulgence of 
Treatment of the nipples .... 
Temperature, of . 

proper in a nursery 



25 

76 



394 



24 

38 

49 

122 

104 



INDEX 



479 



Temperature, children at an early age not to be exposed to grea 
changes ...... 

danger of attempting to " harden n children . 
Teething . . . ... 

general observations on the appearance of the teeth 
$ 1. Phenomena of dentition .... 

signs of teeth about to pierce the gums 

symptoms are not constant .... 

the process of cutting teeth not mechanical 

observations on use of the coral. &c. . 

nature and shape of coral of importance . 
$ 2. Second dentition ..... 

phenomena of this process 

parents often neglect their children's mouth at this period 

changes that take place in the person at this period . 

first set of teeth not displaced mechanically by the second 

reasons why the teeth are shed 

order in which the second set appear 

See Dentition. 
Tongue-tie ....... 

arises from two causes .... 

1. Adventitious tying of the tongue 
mode of remedying .... 

2. Original conformation of the fraenum rendering the tongue 

too short ..... 

danger attendant on dividing fraenum 
Tongue, of swallowing and hemorrhage 

Dr. Underwood's account of it . . . . 

Petit's mode of remedying . „ 

hemorrhage to any extent, ought never to take place in 

dividing the fraenum .... 
plan proposed in case of hemorrhage . 



Par. 

450 

452 

654 

668 
674 
675 
678 
681 

684 
685 
686 
690 
691 
693 



1143 
1147 

1149 

1150 
1151 



1154 305 
1156 305 



u 



Ulceration of the mouth 
treatment 
symptoms . 

of easy cure if taken early 
arising from cutting teeth 
Dr. Underwood's opinion 
Urine, incontinence of 

most frequently a disease of habit 
mode of curing such cases 
interesting case 
Urticaria, or Nettle Rash 

Dr. Good's definition of 

symptoms 

danger from retrocession 

causes 

treatment 

of the chronic form . 



1037 
1039 
1039 
1040 
1041 

1218 
1220 
1221 

1726 
1729 
1731 
1727 
1741 
1744 



V. 



Ventilation of nursery, importance of 



Vomiting 



391 



103 
325 



480 



INDEX. 



Vomiting, 

not always a disease 

division into three species .... 

§ 1. Idiopathic vomiting .... 

definition of 

causes of, and treatment .... 

$ 2. Sympathetic vomiting ..... 

causes ...... 

treatment when arising from a suppression of discharge 

&c. ...... 

treatment, when from some acrid or deleterious substances 

in the stomach ..... 
treatment, when arising from the deranged powers of the 

stomach ...... 

from excess of acid ..... 

from deficiency of acid .... 

Vagina, discharges from ..... 

in very young children 

in children of more advanced age . 

if not checked is detrimental 

treatment ...... 



W. 

Weaning ....... 

general observations . . . . . 

$ 1 . On the part of the mother .... 

causes which may render it improper for the mother to 
suckle ...... 

constitutional affection of mother 

child never injured by suckling whilst the mother is 

labouring under fever . 
local diseases of mother 
from diminished supply of milk . 
from pregnancy taking place 
$ 2. On the part of the child 

A. On the teeth .... 
number of teeth better guide than its age 
Dr. Struve's opinion 

B. State of the child's health . 
should not be weaned when sick 

§ 3. Of the season of the year 

best season to wean in 

child should be previously prepared 

rules for weaning 

mode of facilitating the process 

error in giving the child food 

most proper diet 

Dr. Clark's opinion . 

mother or nurse not to be neglected 

rules to be followed by them 
Worms ..... 
Dr. Butter's extraordinary opinion 
children under ten months not subject to them 
they are introduced with the food 
instances of other animals living in the bowels 
division into classes .... 



Par. 

1231 
1232 

1234 
1236 

1238 

1240 

1241 

1234 
1246 
1250 

1783 
1784 

1785 
1786 



624 



625 
625 

626 
627 
628 
629 



633 
635 

637 

638 
639 
640 
646 
647 
648 
650 
651 
652 

1619 
1620 
1621 
1626 
1629 



Page 

323 
323 
323 
323 
324 
324 
324 
324 
325 
326 
324 



INDEX . 



481 



Worms, 

§ 1. Alvine worms 

Dr. Good's account of . 

different species of alvine worms 
$ 2. Anal worms 

Dr. Good's definition of 

different varieties of 
§ 3. Erratic worms 

treatment of worms 

symptoms as given by Heberden 
Worms injure in three ways 

1 . By irritation 

cases ..... 

2. By destruction of the proper nourishment of the child 

the anal worms do not create emaciation . 

3. By their bulk from accumulation . 

case ...... 

division of worm medicines 

observations on commencing cure with purgatives 
best remedy for long round worm 
ascarides . 
taenia .... 

after treatment to be pursued 
Whitlow ....... 

divided into four species .... 

symptoms of first species .... 

second .... 

third ..... 

fourth . . • . 

causes ....... 

cure of first and second species 
third and fourth " 



Par. 



1630 
1631 

1633 
1634 



1642 
1645 

1648 

1656 

1657 
1661 
1664 
1665 
1672 
1674 
1676 

1772 
1773 

1774 
1775 
1776 
1778 
1779 
1781 



Page 

421 
421 
421 

422 
422 
422 
422 
423 
424 
425 
426 
426 

427 
427 
427 
429 
429 
430 
431 
432 
433 
456 
456 
456 
456 
456 
457 
457 
457 
457 



THE END 



31 



3^1 






LIBRARY OF CONGRESS 



022 216 185 A 



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